67 years, Female, parkinsonism with brisk reflexes. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Few scattered foci of susceptibility effect compatible with chronic microhemorrhages and nonspecific. Major flow-voids are preserved. There is mild cerebral and cerebellar parenchymal volume loss with slightly more prominent volume loss involving the superior cerebellar vermis, which is nonspecific. There is also mild inferior cerebellar vermis hypoplasia which can be normal developmental variant.Orbits and sella are grossly unremarkable. Mild scattered paranasal sinus opacification. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis. C6-7: Disc osteophyte complex and ligamentum flavum thickening contribute to mild spinal canal stenosis. Mild to moderate left and minimal right neural foraminal stenosis. Small perineural cysts. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. No intracranial mass or mass effect. Mild chronic small vessel ischemic changes in the brain. 2. Mild parenchymal cerebral and cerebellar volume loss with slightly greater involvement of the superior cerebellar vermis which may relate to chronic alcohol use, for example. Cerebellar volume loss related to MSA-C may also be considered in the appropriate clinical setting.3. Mild degenerative changes in the cervical spine without cord signal abnormality or high-grade stenosis at any level. Additional details of the degenerative changes as above.