Clinical question: Mass or infectious lesion? Signs and symptoms: 51 year-old female with intractable headache, limited vertical gaze. Pre-and post enhanced brain MR:Negative diffusion weighted series.There is normal anatomical development and morphology brain parenchyma with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal enhancement of brain parenchyma or the meninges is detected.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.Pre and post enhanced cervical MRI:There is normal anatomical alignment of the vertebral column however mild straightening of cervical lordosis which may be positional.There is generalized uniform narrowing than expected size of the spinal canal which is believed to represent congenitally small canal/short pedicles.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes however mild central spinal stenosis or congenital is present.C3-C4 demonstrate mild disc disease, mild bilateral uncovertebral hypertrophic changes without significant facet or ligamentum flavum hypertrophy. There is a tiny central disc protrusion which in combination with congenitally small canal results in moderate central spinal stenosis at this level. Moderate bilateral neural foraminal compromise is also best appreciated on oblique sagittal plane images.C4-C5 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum degenerative changes. Mild central spinal stenosis without neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, moderate asymmetrical left sided uncovertebral hypertrophy and mild bilateral (R>L) facet disease. Moderate left and patent right neural foramina and mild central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral uncovertebral hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. No significant facet disease. Constellation of changes results in slight flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate to severe right and mild left neural foraminal compromise is present.C7-T1 is unremarkable with the exception of mild symmetrical bilateral ligamentum flavum hypertrophy.T1-T2 and T2-T3 levels are unremarkable.There is subtle increased T2, T2 STIR signal intensity of the cord primarily at C6-C7 disc level concerning for myelopathy.Postcontrast images demonstrate no abnormal enhancement of the cord or the leptomeninges and no detectable abnormal enhancement of the vertebral column.
1.Negative pre and post enhanced brain MRI.2.Pre and post cervical MRI demonstrate no abnormal enhancement. There is evidence of congenitally small canal with resultant moderate central spinal stenosis at C6-C7, mild to moderate central spinal stenosis at C3-C4 levels as detailed. Multilevel neural foraminal compromise (some severe) as detailed per level. Subtle T2 STIR hyperintensity of the cord at C6-C7 concerning for adenopathy secondary to degenerative disease.