63 years, Female, found down, unknown fall or cervical spine injury. Seizures. Hyperdense left occipital lesion on CT. Brain: There is an approximately 22 x 15 x 26 mm intraparenchymal hematoma in the left posterior paramedian parietal lobe with T1 and T2 hyperintensity compatible with subacute age. There is surrounding edema and local mass effect including partial effacement of the trigone of the left lateral ventricle. There is no midline shift or herniation. No abnormal enhancement associated with the hematoma is appreciated, although follow-up after resolution of these relatively acute blood products would be helpful. No restricted diffusion to suggest acute ischemia. No abnormal parenchymal or meningeal enhancement elsewhere in the brain. No hydrocephalus.There is evidence of chronic hemorrhage with slitlike encephalomalacia involving the right posterior lateral putamen and external capsule. There is also an additional focus of hemosiderin staining involving the right subinsular white matter slightly more anteriorly. Additional punctate microhemorrhage is present in the right frontal lobe slightly more superiorly.Several foci and patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but compatible with moderate chronic small vessel ischemic disease. There is extensive opacification throughout the paranasal sinuses. There is also extensive bilateral mastoid air cell opacification, left greater than right. Calvarium and extra cranial soft tissues are grossly unremarkable.Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis which may be in part positional. There is also trace retrolisthesis of C4 on C5. Alignment is otherwise grossly maintained. Bone marrow signal is benign.There is abnormal T2 signal in the cervical cord at the C3-C4 level just below the discs space favored to represent myelomalacia although component of edema is not entirely excluded. There is longitudinal low T2 signal involving the right lateral aspect of the cord at the which extends from the upper C3 to the upper C4 level likely representing chronic hemorrhage. No surrounding edema or cord swelling to suggest that this is recent.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: There is a disc osteophyte complex including a left paracentral disc extrusion which along with ligamentum flavum thickening contributes to moderate to severe spinal canal stenosis at this level. There is abnormal, likely associated, T2 cord signal abnormality just inferior to this level. There is also moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy.C4-5: Disc osteophyte complex and uncovertebral hypertrophy contribute to mild spinal canal stenosis. There is also uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis.C5-6: No significant compromise to the spinal canal. Uncovertebral hypertrophy results in moderate right neural foraminal stenosis. Left neural foramen is patent. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.No findings to suggest ligamentous injury in the cervical spine. Paraspinous soft tissues are grossly unremarkable.
1. Subacute intraparenchymal hematoma in the left parietal lobe. No underlying mass is appreciated, although follow-up once the relatively acute blood products resolve would be helpful.2. Three additional foci of chronic hemorrhage are seen in the right frontal lobe and right subinsular white matter/putamen.3. Moderate chronic small vessel ischemic disease.4. Degenerative changes in the cervical spine including moderate to severe spinal canal stenosis at the C3-C4 level which is primarily related to left paracentral disc extrusion. There is associated T2 signal abnormality favored to represent myelomalacia, although component of edema is not entirely excluded.5. Longitudinal low T2 signal involving the right lateral aspect of the cervical cord from the upper C3 to the upper C4 level suspected to represent a chronic hemorrhage. No associated mass or cord swelling.