55 years Male (DOB:12/27/1960)Reason: R/o neurodegenerative process History: Abnormal ocular movements w/ delirium, h/o EtOH abusePROVIDER/ATTENDING NAME: WEI WEI LEE SACHIN DILIP SHAH MRI brain:There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Multiple Punctate T2 and FLAIR hyperintense foci are present in the thalami and basal ganglia. Patchy T2 and FLAIR hyperintense lesions are present in the brainstem.No foci of diffusion restriction are appreciated.There several punctate foci of signal loss on susceptibility weighted imaging present in the midbrain and basal ganglia and the left thalamus.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Postcontrast imaging is mildly degraded patient motion artifact which may obscure more subtle abnormalities.Marrow signal in the visualized cervical spine and calvarium is rather low. There is patchy areas of marrow replacement present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is superior endplate compression present at T12 associated with a Schmorl's node. There is no associated T2 signal hyperintensity with this compression fracture to suggest that it is acute. There is a 12 x 9 mm well-circumscribed T1 hyperintense lesion along the posterior aspect of the T12 vertebral body which suppresses on the STIR sequence and most likely represents a vertebral body hemangioma. Marrow signal in the lumbar spine is rather low with patchy marrow replacement in the lumbar spine. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is mild loss of disc space height, diffuse disc bulge and some ligamentum flavum hypertrophy associated with effacement of the fat at the right lateral recess. Overall there is mild to moderate encroachment of the nerve roots of the right lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some mild loss of disc space height. There is also mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Chronic superior endplate compression at T12.2.There is a disc bulge at L4-5 associated with some mild to moderate encroachment of the nerve roots at the right lateral recess.3.Findings are compatible with multiple old lacunar infarcts in the thalami and basal ganglia.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Patchy signal hyperintensity within the brain stem is present especially in the central portion of the pons and midbrain. This is a nonspecific finding. It is possible that it is vascular related though it is nonspecific. It is also not classic for central pontine myelolysis, however, it may represent a milder form of CPM.6.There are several microhemorrhages present in the upper brainstem and deep gray nuclei. Most likely these are related to hypertension based on the distribution.7.There is marrow replacement present which is a nonspecific finding. It can be associated with chronic disease, anemia, lymphoproliferative disorder. It is nonspecific.