History of head and neck cancer. Bilateral lower extremity pain and generalized weakness. Brain: There is encephalomalacia with T2/FLAIR hyperientensity and mild volume loss involving the left inferior parietal lobule involving the angular gyrus. Associated T1 hyperintensity compatible with laminar necrosis. There are also multiple small areas of encephalomalacia involving the bilateral cerebellar hemispheres indicative of remote infarcts. No evidence of acute ischemia. No intracranial mass or mass effect. There is mild global parenchymal volume loss. No hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Small left maxillary sinus mucus retention cysts. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine:There is motion degradation, particularly on the axial T2 sequence. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. No suspicious osseous lesions are seen.There is questionable patchy T2 signal abnormality involving the cervical spinal cord from the C4 to C7 level without any evidence of cord swelling. No abnormal enhancement.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild spinal canal narrowing related to small disk osteophyte complex and ligamentum flavum thickening. There is mild to moderate left neural foramina stenosis.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is disk osteophyte complex with mild to moderate spinal canal stenosis including mild indentation of the cord. There is mild bilateral neural foraminal stenosis. C6-7: There is disk osteophyte complex with mild spinal canal stenosis. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. No significant right neural foramina narrowing.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.
1. No evidence of acute ischemia or intracranial mass effect. 2. Chronic infarcts in the left inferior parietal lobule and bilateral cerebellar hemispheres.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C5-C6 and mild indentation of the ventral cord. There is questionable mild T2 hyperintensity in the cervical cord at the C5-C6 level which may be artifactual. No abnormal enhancement. 4. Mild to moderate neural foramina narrowing at C3-C4, C5-C6, and C6-C7 as detailed above.