 No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is appropriate for patient's age. No hydrocephalus. No extra-axial collections. There is patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, which is nonspecific, but compatible with moderate chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal mucosal thickening in the paranasal sinuses. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE
1. Moderate of chronic small vessel ischemic changes. MRI of the brain is otherwise unremarkable for age.2. No abnormal cord signal. Mild degenerative changes without high-grade spinal canal or neural foraminal stenosis in the cervical or thoracic spine.3. Abnormal enhancement involving the dorsal epidural space at the L1-L2 level as well as subtle enhancement involving the dorsal paraspinous soft tissues as well; finding may represent sequela of prior lumbar puncture or epidural injection. There is also a disc extrusion which is present extending from the T12-L1 level to the mid L2 level. These findings along with ligamentum flavum thickening and facet arthropathy result in mild to moderate degree of spinal canal stenosis at the L1-L2 level.4. Moderate to severe spinal canal stenosis at L4-L5. There is also moderate bilateral neural foraminal stenosis at this level which may be impinging on the bilateral L4 nerve roots.5. Please note post gadolinium images of the cervical and thoracic spine were not obtained as patient did not want to complete these sequences.