Male 58 years old Reason: cervical stenosis and progressive extrapyramidal symptoms of uncertain origin History: brisk reflexes. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There is variable multilevel disc height loss most prominent at the C5-6 level. There is no focal worrisome marrow signal abnormality. Likely benign hemangiomas involving the T1 and T3 vertebral bodies. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: Small left greater than right disc osteophyte complex and mild right greater than left facet arthropathy. No significant spinal canal or neural foraminal compromise. No interval changes.C3-4: Small disc osteophyte complex which is slightly progressed compared to the prior exam and now has a small left foraminal disc protrusion, uncovertebral and facet hypertrophy. Minimal right and moderate left neural foraminal narrowing. No spinal canal stenosis. C4-5: Small disc osteophyte complex, uncovertebral and right greater than left facet hypertrophy which has progressed slightly compared to the prior exam. Moderate bilateral foraminal narrowing. No spinal canal stenosis.C5-6: Disc osteophyte complex, left greater than right uncovertebral spurring and mild facet hypertrophy which has mildly progressed. Mild right and moderate to severe left neural foraminal narrowing. No spinal canal stenosis.C6-7: Small disc osteophyte complex, slightly progressed. Bilateral uncovertebral spurring and mild facet arthropathy. Mild bilateral neuroforaminal narrowing. No spinal canal or right neuroforaminal stenosis.C7-T1: Small disc osteophyte complex with a small left paracentral disc which lesion which contributes to mild left foraminal narrowing. No spinal canal stenosis.
No acute abnormalities involving the brain.Multilevel degenerative changes involving the cervical spine which have mildly progressed compared to the previous exam from 3/9/2013 without spinal canal stenosis. Scattered foraminal narrowing is seen, most severely affecting C5-6 on the left.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.