Slurred speech, left hand weakness Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Minimal retrolisthesis is seen at C3 on C4. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.There is mild congenital narrowing of the spinal canal with superimposed degenerative changes as described below: At C2-3 there is a small central disk protrusion with no significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.At C3-4 there is no significant change in disc protrusion and facet osteophytes as well as ligamentum flavum hypertrophy which results in moderate-severe stenosis of the spinal canal. The thecal sac is effaced and there is flattening of the cord which demonstrates normal signal. There is moderate left and mild to moderate neural foraminal stenosis. At C4-5 there has been no significant change in the moderate to severe canal stenosis as result of the central disk protrusion. The thecal sac is effaced and the cord is mildly deformed. The cord demonstrates normal signal. There is mild to moderate left and mild right neural foraminal stenosis. At C5-6 there is a central disk protrusion, uncovertebral, and facet joint arthropathy which result in moderate canal stenosis including thecal sac effacement. The cord demonstrates normal signal. There is moderate to severe right greater than left neural foraminal stenosis.At C6-7 minimal disc bulge without significant spinal canal stenosis. There is mild right neural foraminal stenosis. No significant left neural foraminal stenosis.At C7-T1 there is a mild disk bulge which does not result in significant compromise of the spinal canal. There is mild bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. No evidence of acute infarct or intracranial mass effect. Minimal chronic small vessel ischemic changes.2. Multilevel degenerative changes in the cervical spine with moderate to severe spinal canal stenosis at C3-C4, C4-C5, and C5-C6. Overall appearance is not significantly changed since 7/3/2013. Associated cord deformity is also similar to prior without new cord signal abnormality. Multilevel neural foraminal stenosis also appears similar, worst at the C5-C6 level where there is moderate to severe stenosis.