Right lower extremity weakness and hyperreflexia, assess for myelopathy. MR brain: Again seen are several foci of T2 hyperintensity in the periventricular and subcortical white matter, all of these similar to the previous exam with the exception of a new T2 hyperintense focus in the right middle cerebellar peduncle. There is no associated restricted diffusion or abnormal enhancement in any of these lesions. No definite acute lesions are seen.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild opacification of the right mastoid air cells. MR cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality seen. There is mild narrowing of the disc height at C5-C6. There is new T2 signal abnormality in the right dorsal cervicomedullary junction (image 9, series 1601). There is no associated pathological enhancement.There is a clear area of abnormal T2 signal along the right lateral cord at C4-C5 which is best seen on image 15, series 1801, which is unchanged. In addition, best seen on sagittal STIR sequences, long segment subtle T2 hyperintensity is suspected in the cord extending from C2 into the lower cervical region, which could be artifactual or may represent subtle disease. On close inspection of the previous exam it may have been perhaps.There is mild-to-moderate degenerative disease in the cervical spine.At C2-3, there is no significant compromise to the spinal canal or neural foramina.At C3-4, there is mild left neuroforaminal narrowing. There is no significant central canal stenosis. At C4-5, there is a right paracentral disc protrusion resulting in mild narrowing of the right neural foramen. There is no spinal canal stenosis.At C5-6, there is a disc osteophyte complex resulting in moderate, left more than the right, foraminal stenosis. There is no spinal canal stenosis. At C6-7, there is a disc protrusion without significant compromise to the spinal canal or neural foramina.At C7-T1, there is no significant compromise to the spinal canal or neural foramina.
1. Several small foci of signal abnormality are redemonstrated in the cerebral white matter. There may be a new lesion in the right middle cerebellar peduncle and at the right dorsal cervicomedullary junction.2. A lesion is noted in the right lateral cord at C4-C5. There is also subtle possible signal abnormality extending over a long segment of the cervical spinal cord, which may have been present on previous imaging. 3. Imaging features of both the intracranial and spinal cord lesions suggests a demyelinating process, post inflammatory sequelae or connective tissue disorders such as SLE.3. Stable multilevel degenerative disc changes of the cervical spine, worst at C5-C6 resulting in moderate bilateral neural foraminal narrowing. No spinal canal stenosis.