Female, 68 years old, with neurofibromatosis type I, with new nystagmus and worsening gait difficulty. Also problems with writing. Brain:No evidence of restricted diffusion, edema or mass effect is seen. No pathologic intracranial enhancement is observed. Predominantly periatrial white matter volume loss is seen with mild patchy T2 hyperintensity in the surrounding periventricular tissues. This is perhaps minimally progressed from prior. No tumor-like lesions are detected. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is seen. Innumerable cutaneous nodules likely representing neurofibromas are demonstrated.Cervical spine:Deformity, thickening and T2 hyperintensity of the spinal cord at the C2 level are unchanged. This lesion itself does not enhance, nor did it on the prior examination. However, just above the level of this lesion, there is bilateral nodular thickening presumably affecting the exiting nerve roots, similar in size to those seen on the prior examination. These lesions do enhance mildly. Nerve root thickening is also suspected within several cervical foramina, most notably C5-6 and C6-7 bilaterally.Straightening of the cervical lordosis is seen. Sagittal alignment is unremarkable. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous, but there are no areas of definite edema or pathologic marrow replacement. Except as above, the spinal canal demonstrates normal signal characteristics and is free of pathologic enhancement.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate left foraminal narrowing. No interval changes. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes. C7-T1: Very small central disc protrusion. No spinal canal stenosis. No foraminal narrowing. An enhancing nodular lesion is seen at the left tracheoesophageal groove at T1. This area was not covered on the prior examination. Innumerable cutaneous neurofibromas are present.
1.No definite acute intracranial abnormality is seen. No intracranial tumors are detected. There is white matter volume loss predominantly affecting the periatrial regions with mild associated parenchymal signal abnormality. Findings have perhaps minimally progressed from prior.2.An area of spinal cord thickening, deformity and abnormal signal is redemonstrated at the C2 level without significant interval change. This could potentially represent a benign spinal cord tumor related to neurofibromatosis.3.Additional small neurofibromas are suspected intrathecally, above the level of the C2 cord tumor, and within several of the cervical foramina. The findings are nonspecific and unchanged from prior.4.Relatively mild degenerative findings in the cervical spine are unchanged with no areas of high-grade spinal canal stenosis.5.Innumerable cutaneous neurofibromas are seen. In addition, there is a nodule along the left tracheoesophageal groove at the T1 level which is nonspecific but could potentially represent a neurofibroma.