Clinical question: Evaluate for brain lesion in posterior fossa. Signs and symptoms: Occipital neuralgia pain right side. Blurry vision. Nonenhanced brain MRI:Negative diffusion weighted images.Images through posterior fossa are unremarkable. Images through supratentorial space demonstrate two tiny nonspecific foci of flair hyperintensity in right frontal subcortical white matter. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF ascites is and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable images through the orbits. No detectable calvarial or soft tissues of the scalp abnormalities.Bilateral mastoid air cells and middle ear cavities are unremarkable in signal intensity.Frothy content of the left larger chamber of the sphenoid sinus and complete opacification of right chamber are consistent with sinusitis and likely acute on the left. The rest of the paranasal sinuses are unremarkable.Nonenhanced cervical MRI:There is normal anatomical alignment the vertebral column similar to prior exam.There is moderate degenerative disease throughout the cervical spine.There is mild retroflexion of dense similar to prior study. There is hypertrophic changes of the dens and surrounding ligaments which results in subtle mass-effect and posterior displacement of cervicomedullary junction of the cord. There is progression of hypertrophic changes since prior exam. There is however no evidence of spinal stenosis at this level and the with normal signal intensity of the cord. There is extensive degenerative and hypertrophic changes at the level of right occipital condyle and C1 articulation. This finding could explain patient's right sided occipital neuralgia.C2 -- C3 demonstrate mild degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate degenerative changes with resultant moderate left neural foraminal compromise.C4 -- C5 demonstrate degenerative disk disease with loss of disk height and mild hypertrophic changes of posterior elements. There is resultant significant left and moderate right neural foraminal compromise. C5 -- C6 demonstrate moderate disk disease and loss of disk height and mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease, shallow broad-based bulging disk, mild facet and ligamentum flavum degenerative changes. No spinal stenosis and moderate left neural foramina compromise.C7 -- T1 demonstrate moderate asymmetric left facet hypertrophic changes without spinal stenosis or neural foraminal compromise.Upper most visualized thoracic spine and cord is unremarkable with the exception of mild degenerative disk disease. Unremarkable paraspinal soft tissues.
1.Nonenhanced brain MRI demonstrate no acute intracranial process, two tiny nonspecific foci of flair hyperintensity in the subcortical white matter right frontal lobe and unremarkable nonenhanced brain MRI otherwise and in particular no detectable abnormality in the posterior fossa as clinically is questioned. Sphenoid sinusitis.2.Nonenhanced MRI of cervical spine demonstrate mild dorsiflexion of the dens, hypertrophic changes of the dens and the surrounding ligaments with interval progression since prior study however without spinal stenosis. There is asymmetric extensive degenerative and hypertrophic changes of right occipital condyles / C1 articulation which could explain patient's right occipital neuralgia. Moderate degenerative changes of the disks and to a lesser degree posterior elements throughout the cervical spine without central spinal stenosis. Neural foraminal compromise however are present as detailed per level above.