Diagnosis: Altered mental status, unspecified Unspecified cord compressionDiagnosis Edits: Clinical question: cord edema extending in the thoracic spine MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots.There is centrally and high signal present within the spinal cord which is more prevalent in the upper thoracic spinal cord in the lower thoracic spinal cord. There is associated mild enlargement of the thoracic spinal cord.There are small bilateral pleural effusions present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild anterior subluxation of L5 on S1 there is endplate reactive changes present with some elevated T1 signal along the endplates at left half of the vertebral bodies suggesting that this is chronic. There is moderate facet hypertrophy present at this level. There is some loss of disc space height and disc desiccation. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy present at this level. There is mild anterior subluxation of L4 and L5. There is partial effacement of the fat at the lateral recess bilaterally at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level. There is loss of disc space height and some endplate reactive change present at this level. The endplate reactive changes are present which have high signal on T1 suggesting that this is chronic.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and some endplate reactive change present at this level. The endplate reactive changes are present which have high signal on T1 suggesting that this is chronic.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is subtle elevated T2 signal present diffusely within the perivertebral musculature.
1.There is diffuse thoracic spinal cord swelling due to central cord abnormality involving spinal cord gray matter which extends down from the lesion identified in the cervical spinal cord. Differential considerations may include ischemia as well as inflammatory/infectious etiologies.2.There are multilevel degenerative changes present in lumbar spine with mild to moderate spinal stenosis at L4-5.3.Small pleural effusions4.There is subtle elevated T2 signal present diffusely within the perivertebral musculature. This is a nonspecific finding. This could be inflammatory or reactive to denervation. It is of unclear significance.