Urinary retention and weakness with a sensory level. Assess for transverse myelitis/ADEM. Additional clinical history from electronic medical records: 32Yrs male with no past medical history who was sent to ER from urgent care for workup of myositis vs myelopathy vs GBS. Exam shows limited upgaze and rapid eye movement 2/2 pain w/o tenderness or inflammation and brisk reflexes. Subjective T10 paresthesia level but no sensory loss. Unlikely GBS given brisk reflexes and no weakness, less likely myositis w/ normal CK, but exam concerning for myelopathy given brisk reflexes, level, and constipation. BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a small right frontal developmental venous anomaly, which is a common incidental finding. 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. Of note, the left posterior cerebral artery is fetal in origin, which is a common variant. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are left maxillary retention cysts. There are small mucosal retention cysts in the nasopharynx.SPINE:Alignment is anatomic. Vertebral bodies are preserved in height. Intervertebral discs are also preserved in height. Marrow is diffusely less fatty than expected without discrete focal lesion or osseous destruction. This is likely benign and related to hematopoietic marrow. Small fat-containing lesions are present in the T1 vertebral body and left L5 pedicle and are most compatible with hemangiomas. There is a small eccentric to the right L5-S1 disc bulge which abuts but does not displace the right traversing S1 and exiting L5 nerve roots. There is no significant degenerative disease at the other levels of the spinal canal is preserved as well as the neural foramina. The spinal cord has normal precontrast signal. The tip of the conus medullaris lies at L1 level. There is faint central contrast enhancement in the lower thoracic spinal cord extending from T8-T9 to mid T11 level. There is also suggestion of faint contrast enhancement along the cauda equina roots. Small T1-hypointense, T2-hyperintense, non-contrast-enhancing kidney lesions may represent cysts but are not completely assessed.
1.Brain: No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Spine: Faint T8-T11 level spinal cord and cauda equina root enhancement is of unknown significance. While this may represent an imaging artifact, the possibility of an underlying inflammatory process is also reduced.  