Female, 69 years old, with falls and changes of handwriting. Assess for cervical myelopathy. Trace retrolisthesis is seen of C4 on C5 and C5 on C6. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous, but no evidence of any concerning marrow replacement or marrow edema is seen.Patchy areas of abnormal signal are evident within the brainstem and the visualized cervical spinal cord. For example, ill-defined abnormal signal is evident within the ventral and left medulla. Additional foci are seen in the left dorsal cord at C3-4, the right dorsal cord at C4-5, and the right lateral cord at C6. At these sites of abnormal cord signal, no evidence of cord swelling is seen, and in fact, some areas show relative volume loss. Of note, many of these areas of abnormal cord signal are located where the spinal canal remains widely patent.Multilevel cervical spondylosis is seen with loss of disc height and endplate irregularity particularly affecting C4-5, C5-6 and C6-7. Additional level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation which may just contact the ventral cord. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. C5-6: Broad posterior disc-osteophyte complex formation which contacts and indents the ventral cord. Mild to moderate generalized spinal canal narrowing. Moderate to severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation which contacts and perhaps mildly indents the ventral cord. Mild to moderate spinal canal narrowing. Mild bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis. Incidental note is made of tubular cystic structures within both parotid glands which somewhat resemble focally dilated ducts.
1. Multiple scattered areas of brainstem and spinal cord signal abnormality are seen. These lesions are not associated with cord swelling, and if anything, there is evidence of cord volume loss which would suggest chronicity. Given that these lesions are found at sites where there is no significant disc disease or canal stenosis, including in the medulla, a systemic process is favored. This could reflect the sequelae of demyelination, prior infection or post infectious/autoimmune myelopathy, sarcoid or SLE among others.2. Multilevel disc degeneration is seen most severely affecting C4-5 through C6-7. There are mild to moderate areas of spinal canal stenosis through this region, and at C5-6, the neural foramina are significantly narrowed.3. Incidental note is made of tubular cystic structures within the parotid glands which could represent focally dilated ducts. The etiology for this finding is uncertain though such lesions can be associated with connective tissue disorders.