Male, 55 years old, with diplopia, facial weakness, multifocal cranial neuropathy, and cervical myelopathy. Brain:Again seen are minimal scattered periventricular foci of T2 hyperintensity. These have not significantly changed from the prior examination.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. Postcontrast images are degraded by motion artifact which limits the ability to detect subtle abnormalities. Given this caveat, however, no definite pathologic parenchymal or extra-axial enhancement is seen.No intracranial hemorrhage or any abnormal extra axial fluid is detected. The ventricular system is normal in size and morphology.C-spine:Image quality is degraded both by motion artifact and artifact induced by orthopedic instrumentation. Within these limitations, the following observations are made.Since the prior examination, decompressive laminectomy has been performed at least partially at C2, then from C3 down to C6. Fusion instrumentation has been placed on the left from C2 through C6, and on the right from C2 through C5.Soft tissue surrounding the odontoid process, likely representing pannus, has increased in size since the prior examination. This results in progressive narrowing of the spinal canal at the C1-2 level but with only mild mass effect upon the spinal cord.The normal cervical lordosis is mildly reversed, a new finding which may at least in part reflect spinal fusion. The vertebral bodies are otherwise well aligned with respect to each other.Vertebral body height and morphology are normal. No concerning marrow space lesions are detected.C2-3: Postoperative findings. Disc osteophyte formation. Mild spinal canal stenosis, but improved from prior. No significant foraminal narrowing. C3-4: Postoperative findings. Disc osteophyte formation. No significant spinal canal stenosis which is an improvement from prior. Mild bilateral foraminal narrowing. C4-5: Postoperative findings. Disc osteophyte formation asymmetric towards the right. Mild residual spinal canal stenosis, improved from prior. Questionable faint T2 hyperintensity versus artifact within the spinal cord. The foramina are not well assessed but mild to moderate stenosis is suspected bilaterally. C5-6: Postoperative findings. Disc osteophyte formation. No significant spinal canal stenosis, improved from prior. The foramina are not well assessed, but at least mild-to-moderate stenosis is suspected bilaterally. C6-7: Postoperative findings. Mild disc osteophyte formation. Perhaps mild spinal canal stenosis, similar to prior. The foramina are not well assessed, but mild to moderate stenosis is suspected bilaterally.C7-T1: Facet hypertrophy. Disc osteophyte formation. Mild spinal canal stenosis without cord impingement. Mild foraminal stenosis is seen bilaterally. Allowing for significant motion degradation and artifact related to orthopedic instrumentation, no definite pathologic enhancement is seen within the osseous elements of the spine or within the visualized portion of the spinal canal.The paraspinal soft tissues are unremarkable. In particular, a nodule which was previously seen in the left parotid gland is no longer evident.
1.Examination of the brain is slightly limited by motion artifact. Allowing for this, no acute or significant intracranial abnormalities are appreciated.2.Evaluation of the C-spine is degraded both by motion artifact and the presence of orthopedic instrumentation. Multiple areas of tight spinal canal stenosis seen on the prior examination have been relieved secondary to surgery.3.Of note, however, is progressive pannus formation at the level of the odontoid process which does result in increasing stenosis at the C1-2 level, but with only mild mass effect on the spinal cord.