Reason: cervical neuroma History: RUE pain. Additional history per chart patient has left upper extremity paralysis secondary to brachial plexus injury status post MVA, HIV, EBV related lymphoproliferative disorder. Also history of brachial plexus exploration and nerve transfer. Again seen is a previously biopsied, enhancing intradural extramedullary lesion along the anterolateral left aspect of the spinal cord extending from the C5 through C7 levels which measures approximately 4 mm in the AP dimension in the sagittal plane and craniocaudally up to 4.4 cm. Compared to 7/17/2012, there is no significant change. Component of the lesion partially tracks along the ventral intradural nerve root at C6 as before. There is mild associated mass effect on the left aspect of the cord. No abnormal signal within the cervical cord or intramedullary mass is evident. The cervical vertebral bodies are appropriate in height. There is unchanged including mild reversal of cervical lordosis. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small central disc protrusion similar to prior. No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing as before. C6-7: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing as before. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Multiple nodules in the parotid glands are again seen including decrease in size of the dominant left parotid lesion which which measures approximately 15 x 11 mm previously 19 x 15 mm, measured in the long and short axis. Mild cervical lymphadenopathy is also again seen but not well evaluated.
1. Mild degenerative changes in the cervical spine are not significant changed in the interval. There is fairly mild right C5-C6 and C6-C7 neural foraminal stenosis. Otherwise no significant spinal canal or neural foraminal stenosis. No cord signal abnormality.2. No appreciable change in enhancing intradural-extramedullary lesion along the left ventral aspect of the cord from C4 to C7 with mild local mass effect on the left aspect of the cord. This lesion has not significantly changed in size dating back to 7/17/2012 and compatible with prior biopsy which was benign.3. Multiple parotid nodules which may represent intraparotid lymph nodes or lymphoepithelial lesions are not significantly changed aside from the dominant partially necrotic lesion on the left which demonstrates decrease in size. Mild cervical lymphadenopathy is also again noted but incompletely evaluated.