Patient with anterocollis and possible dystonia. Please evaluate C1 -- C2 (non-legible wording) non-infused head CT, history of subdural hematoma weighted (non-legible wording). Non-infused head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.There is generalized slight prominence of cortical sulci of left hemisphere compared to the right. There is however no evidence of any density abnormality of the left cerebral hemisphere. Considering provided clinical history of subdural hematoma which is no longer identified on this exam, the findings of the left hemisphere may be result of posttraumatic volume loss. This can be further evaluated with a dedicated MRI of brain.Visualized paranasal sinuses and mastoid air cells are unremarkable.Calvarium is intact.CT of the cervical spine:There is reversal of cervical lordosis to a kyphotic deformity. On sagittal 2-D reformatted images there is grade 1 retrolisthesis of C3 in respect to C4. There is apparent mild anterior displacement of the entire C1, C2 and C3. This finding is best appreciated on sagittal reformatted images. This results in more anterior projection of the posterior arch of C1 compared to the posterior lip of foramen magnum. There is however maintained alignment of C1 and C2 and C3. There is no definitive evidence of any fracture. On coronal reformatted images there is evidence of a slight widening of the articulating space between the right occipital condyles and right lateral mass of C1 compared to the left. The clinical significance of this finding is not clear however this finding may be result of an old injury or due kyphotic deformity of cervical spine. On reformatted images the subarachnoid space at the level of foramen magnum and C2 -- C3 levels are identified both posteriorly and anteriorly. There is however effacement of the subarachnoid space at the level of grade 1 anterolisthesis of C3 -C4 with suggestion of central spinal stenosis.At C4 -- C5 level mild degenerative disk disease and bulge of disk material is noted. Subarachnoid space anterior and dorsal to the cord on reformatted images is identified.At C5 -- C6 and C6 and C7 levels there is moderate degree of degenerative disk disease and sclerotic changes of the adjacent endplates are noted. These changes are primarily along the anterior aspect of intervertebral disk space likely result of kyphotic deformity. Shallow ventral hypertrophic spur at these levels is also present.
1.Non-infused head CT demonstrates no evidence of an acute intracranial findings. There is no evidence of residual subdural as clinically is mentioned. There is generalized prominence of cortical sulci in the left hemisphere compared to the right which may indicate underlying parenchymal volume loss. If further evaluation is desired an MRI examination can add additional information of the cause of this finding. Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable.2.Non-infused CT of cervical spine demonstrate grade 1 anterolistheses of C3 in respect to C4 with effacement of the subarachnoid space at this level and possible central spinal stenosis. There appears that the entire C1, C2 and C3 has shifted forward in respect to C4 and posterior lip of foramen magnum. There is however normal articulation of the occipital condyles and C1. Mild to moderate degenerative disk disease primarily at C5 -- C6 and C6 and C7 levels as described above.