Diagnosis: Radiculopathy, lumbar regionClinical question: please do Dr Javed MS protocol and compare to priorSigns and Symptoms: vertigo, headache MRI brain:There is redemonstration of a 4 mm x 5 mm focus of enhancement in the right pons which is hypointense on T1 and was previously hyperintense on FLAIR imaging. On the T2 sagittal cervical spine images it is hyperintense on the STIR T2 images. Susceptibility weighted imaging on the prior exam demonstrates some susceptibility effect.There is a mild degree of periventricular and subcortical white matter lesions present which are asymmetrically more numerous in the left hemisphere relative to the right. Compared to the previous exam these lesions appear somewhat more conspicuous on the current exam but have not changed in number or size. The difference in conspicuity can be accounted for on the basis of slice thickness.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is mild reversal of the normal cervical curvature present. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level which was also present on the prior examAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is redemonstration of a small central disc protrusion at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.The left lobe of the thyroid is heterogeneousLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is a T1 hyperintense focus in the L3 vertebral body which is eccentric towards the right side and measures 11 mm in diameter and most likely represents a vertebral body hemangioma. It suppresses on the inversion recovery images and the fat suppressed images. No abnormal enhancing lesions are appreciated in the spinal canal.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level. There is disc desiccation and a minor disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some mild loss of disc space height and a minor disc bulge at this level.. There is 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.There is a punctate enhancing lesion in the pons. It was also present on the prior exams from 2010 and 2009 and has not changed substantially. It is possible this represents capillary telangiectasia 2.There is a mild degree of periventricular and subcortical white matter lesions present which are nonspecific. Although it is conceivable that these are related to demyelinating disorder at this age they're more likely vascular related based on the imaging appearance and frequency of occurrence.3.There are mild degenerative changes present in the lumbar spine and the cervical spine without significant compromise to spinal canal or exiting nerve roots.4.Heterogeneous left lobe of thyroid is nonspecific finding.