Clinical question: Bleed. Signs and symptoms: Fall. Non-enhanced head CT conalthere is no evidence of intracranial hemorrhage, edema mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray white matter differentiation is within normal.Calvarium, limited view of paranasal sinuses, mastoid air cells and scalp demonstrate no abnormality.Nonenhanced CT of lumbar spine:There is normal alignment the vertebral column. Diffuse area of thickened bony trabeculation involving the body of L1 vertebrae is believed to represent a hemangioma. This finding is best appreciated on axial image 18. The bony density of the lumbar spine is otherwise unremarkable. No evidence of fracture is identified. There is mild to moderate degenerative disk disease and multilevel bulge of disk material. There is also moderate hypertrophic changes of posterior elements of the ligamentum flavum and facet complexes. There is no measurable central spinal stenosis however this should be further evaluated with an MRI. Hypertrophic changes of posterior elements are most noticeable and prominent at L4 -- L5 level with resultant mass effect on the thecal sac with forward displacement.Nonenhanced CT of cervical spine:Extensive degenerative disk disease more severely at C5 -- C6 is present. Very extensive and prominent anteriorly projecting osteophytes from C2 level to T1 level are noted along the anterior aspect of vertebral column. There is evidence of mass effect on the soft tissues of the neck.There is no evidence of fracture or malalignment. There is normal articulation of occipital condyles with C1 and C1 with C2.
1.Negative nonenhanced CT of brain.2.CT of the lumbosacral spine demonstrates no evidence of fracture or malalignment.3.CT of cervical spine demonstrates no evidence of fracture or malalignment. Extensive degenerative disk disease and very large hypertrophic spurs project anteriorly into the soft tissues of the neck and there is no significant spur posteriorly within the spinal canal.