Diagnosis: Chronic tension-type headache, not intractableClinical question: mass lesion causing new onset headaches and left arm weaknessSigns and Symptoms: HA, left arm weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate a small mucous retention cyst in the left maxillary sinus. 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. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.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 present at this level.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge present this level associated with some uncovertebral osteophytes with mild encroachment ofAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge present at this level. There is mild ligamentum flavum hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge present at this level. There is mild ligamentum flavum hypertrophy 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.There is a hyperintense T1 focus present in the T2 vertebral body measuring 8 mm in diameter most likely representing a vertebral body hemangioma.
1.There are degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.2.There is no evidence for intracranial mass lesion or cerebral infarction.