Reason: eval chordoma, eval for pathology History: weakness.. Brain MRIThere is multifocal patchy periventricular white matter hyperintensity on FLAIR images, which likely represents small vessel ischemic disease of indeterminate age and is unchanged compared to prior MRI. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.C SpineThe high signal prevertebral mass that was previously seen anterior to the C3 vertebral body and extending along the anterior longitudinal ligament demonstrate interval decrease in size. There is again demonstration of high signal intensity of the C3, C4, and C5 vertebral bodies, not significantly changed compared to prior MRI. The vertebral bodies of C3, C4, and C5 are again seen to enhance with contrast. The cervical and thoracic spinal cord demonstrates diffuse high intensity on T2 weighted images compared to prior exam, which is consistent with post-radiation spinal cord edema. There is new enhancement of the spinal cord at the C4-C5-C6 level, which is favored to represent postradiation myelopathy, with metastasis less likely. Thoracic SpineThere is no evidence of compression of the thoracic spine. There is diffuse high signal intensity on T2-weighted images of the thoracic spinal cord extending to the T5 level. Lumbar SpineThere is mild foraminal narrowing bilaterally at the L1-L2, L2-L3, and L3-L4 levels with mild foraminal stenosis bilaterally. There is diffuse intervertebral disc bulge at the L3-L4 level. There is diffuse intervertebral disc bulge also at level L5-S1. There is spondylolisthesis at the L4-L5 level and severe central canal stenosis at the L4-L5 level. The conus medullaris is normal at the L1-L2 level, with normal signal intensity. There is evidence of diffuse disc desiccation.The bladder is distended with fluid. The paraspinal soft tissues are unremarkable.
1. No evidence of intracranial hemorrhage, mass, or acute infarct. Nonspecific chronic small vessel ischemic disease of indeterminate age.2. Interval decrease in size of the previously identified extracorporeal mass anterior to vertebral body C3. However, no significant change in MR characteristics of the vertebral bodies compared to prior exam.3. There is new spinal cord enhancement at the C4-C5-C6 level, which favors radiation-induced myelopathy, cannot exclude metastatic lesion.4. Diffuse increased signal of the cervical and thoracic spinal cord extending from C1 to T5 on T2-weighted and STIR images, which is suggestive of postradiation spinal cord edema.5. Severe central canal stenosis at the L4-L5 level secondary to vertebral spondylolisthesis.