Sinus symptoms: Lower extremity weakness, recent fall. Clinical question: Evaluate for fracture. Non-enhanced CT brain:There is no evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Findings consistent with small vessel disease of indeterminate age are noted.Calvarium is intact. Limited view of paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable. No abnormality of the scalp is thickened.Nonenhanced CT of thoracic spine:Examination demonstrate a fracture along the horizontal plane bisecting the 10th vertebral body into superior and inferior halves fracture extends posteriorly and extends across the right pedicle and right pars inter-articularis. On the left fracture also extends across the left pedicle and left pars inter-articularis. There is also fracture of the spinous process of T10. There is evidence of slight retrolisthesis of the inferior half of T10 fracture vertebrae and lower thoracic spine in respect to the upper half of fracture T10 vertebrae. This subluxation result in mass effect and deformity of the cord both anteriorly and posteriorly and the AP diameter of the canal at this level measures 6-mm. axial images demonstrate bilateral pleural effusion which may represent hemorrhage. This finding is significantly more pronounced on the right. There is no definite evidence of paraspinal hemorrhage or edema or mass. Follow-up with an MRI is recommended for further assessment in particular of the cord.There is no definitive evidence of fracture at other levels. The alignment of the spine a bulb and below the fracture remains unremarkable.Heavy calcification of the interspinous ligament throughout the thoracic spine.Nonenhanced CT of lumbar spine:There is no evidence of fracture or subluxation. Extensive degenerative disk disease with large omental hypertrophic spurs and bulging disks results in multilevel height is suspected central spinal stenosis. These findings are more pronounced at L2 -- L3 and L4 -- L5 levels. I suspect multilevel neural foramina compromise also.
1.Negative CT of brain for post traumatic findings. Small vessel disease of indeterminate age.2.A linear fracture in horizontal plane bisects the T10 vertebral body in superior and inferior halves. The fracture extends to bilateral T10 pedicles and bilateral pars inter-articularis and spinous process.3.There is slight retrolisthesis of the lower T10 vertebral body in respect to the upper. There is resultant 6 mm central spinal stenosis.4.Extensive degenerative changes of thoracic spine and heavy calcification of interspinous ligament5.no evidence of fracture or subluxation in the lumbar spine.6.Extensive degenerative disk disease with multi-level central spinal stenosis and lumbar spine. I suspect that multilevel neural foramina compromise.