Diagnosis: Dizziness and giddinessClinical question: please do Dr. Javed pMS protocol on 3 T MRISigns and Symptoms: dizziness, fatigue MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical white matter lesions present which are hyperintense on T2 and FLAIR MRI.No abnormal enhancing 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 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. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disk dessication present.There is a 12x12mm T2 and T1 hyperintense enhancing lesion within the right anterolateral portion of the C6 vertebral body.There is a 12x12mm T2 and T1 hyperintense enhancing lesion within the right posterolateral portion of the T2 vertebral body.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.At C4-5 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present bilaterally associated with disk material and narrowing of the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this level. There are small left sided uncovertebral osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a left lateral recess disk protrusion at this level associated with small uncovertebral osteophytes.The vertebral artery flow voids appear to be intact.
1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.2.No intrinsic cervical spinal cord lesions are detected.3. There are mild degenerative changes in the cervical spine as detailed above worse at C4-5 where there is mild to moderate encroachment of exiting nerve roots bilaterally.