Clinical question: Cervical disease? Fibrosis. Signs and symptoms: Lower extremity hyperreflexia. Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally of the pons. Findings are nonspecific however often represent microvascular ischemic changes. Unremarkable CT renal cortex, cortical sulci, ventricular system and CSF spaces for age.No detectable abnormal parenchymal or leptomeningeal enhancement is detected.Unremarkable calvarium and images through the orbits including axial fat sat post enhanced series.Small left paramedian occipital scalp lipoma measuring at 9 x 26 mm in transaxial dimensions is identified of no clinical significance.Signal void of major intracranial arterial branches are identified.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal signal intensity.Pre- and post enhanced cervical MRI:Examination demonstrates normal anatomical alignment of vertebral column.The signal intensity of vertebral column is within normal other than subtle changes related to degenerative disease. There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.Post enhanced images demonstrate no detectable abnormal enhancement of the cord or the meninges.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative disc disease, moderate left and mild right ligamentum flavum hypertrophy and mild facet disease. Changes results in significant left and moderate right neural foraminal compromise and mild central spinal stenosis.C4-C5 demonstrate moderate disc disease and loss of disc height, asymmetric (right greater than left) uncovertebral hypertrophic changes and mild facet and ligamentum flavum degenerative changes. Constellation of changes results in significant right moderate to significant left neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate moderate to advanced disc disease and loss of disc height, asymmetric right greater than left facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is resultant significant right and moderate to significant left neural foraminal compromise and no central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild bilateral facet disease and no significant ligamentum flavum hypertrophy. Constellation of changes results in significant left and moderate right neural foraminal compromise and no central spinal stenosisC7-T1 demonstrate mild degenerative changes without central spinal stenosis. Mild bilateral neural foraminal compromise is suspected.Visualized paraspinal soft tissues are unremarkable.
1.Pre- and post enhanced brain MRI demonstrate no acute intracranial process. Findings suggestive of mild to moderate chronic small vessel ischemic strokes only in the subcortical and periventricular white matter and minimally of the pons. Small left paramedian occipital scalp lipoma measuring 19 x 26 mm. Unremarkable pre and post enhanced brain MRI otherwise.2.Pre- and post enhanced MRI of cervical spine demonstrate mild to moderate degenerative disc and hypertrophic changes of posterior elements. There is mild central spinal stenosis at C3-C4 level. There are multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. Normal signal intensity and caliber of the cord. No detectable significant abnormal enhancement.