Altered mental status demyelination versus concussion related injury. Left upper extremity and left lower extremity hyperreflexia. Brain: Brain parenchyma appears within normal limits. No lesions to suggest demyelinating disease. No evidence of hemorrhage or traumatic encephalomalacia. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Cerebellar tonsils are borderline low without evidence of crowding at the foramen magnum. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Examination is slightly motion degraded but no discrete lesion or signal abnormality in the cervical cord is appreciated. No abnormal enhancement. Individual levels as 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: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.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.
Brain and cervical spine MRI appear within normal limits. Specifically, no findings to suggest demyelinating disease. No appreciable evidence of traumatic injury to the brain or cervical cord.