Female, 53 years old, with sudden onset neck pain and weakness in left arm 3 days ago. Cervical radiculopathy and concern for epidural abscess. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. A small area of encephalomalacia in the head of the left caudate nucleus is suggestive of a chronic lacunar infarct. Patchy mild T2 hyperintensity in the pons is seen, left side more than right. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact on T2 imaging. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:Artifact from patient motion limits examination. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is a relatively large lipoma subcutaneously in the right lower neck. Paraspinous soft tissue structures otherwise appear within normal limits. No pathologic enhancement is identified.Degenerative changes are seen in the cervical spine as described below:C2-3: Mild bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.C3-4: Small posterior disc osteophyte complex mildly narrowing the spinal canal and effacing the ventral thecal sac. Bilateral uncinate hypertrophy and facet arthropathy. Moderate right and moderate to severe left neural foraminal narrowing.C4-5: Small posterior disc osteophyte complex, which effaces the ventral thecal sac. Bilateral uncinate hypertrophy and facet arthropathy. Mild spinal canal stenosis. Moderate to severe bilateral neural foraminal narrowing.C5-6: Small posterior disc osteophyte complex. Bilateral uncinate hypertrophy and facet arthropathy. No significant spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis.C6-7: Small posterior disc osteophyte complex. Bilateral uncinate hypertrophy and facet arthropathy. No significant spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.
1. No evidence of acute infarct, intracranial mass or pathologic intracranial enhancement. Small chronic lacunar infarct in the head of the left caudate nucleus. Mild non-specific signal abnormality in the pons, perhaps also related to small vessel ischemic disease.2. No evidence of spinal epidural abscess, spinal cord compression, or abnormal spinal cord signal. Multilevel degenerative changes in the cervical spine resulting in mild spinal canal stenosis at C3-4 and C4-5. Moderate to severe neural foraminal narrowing on the left at C3-4 and bilaterally at C4-5 and C5-6.