Female, 51 years old, with severe headaches and family history of aneurysms. Also with neck pain. Assess for disk impingement. Brain:Numerous scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres, largely in a peripheral and subcortical distribution.No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.No evidence of intracranial hemorrhage or abnormal extra axial fluid collection noted. The ventricles are normal in size and morphology.There is a mucus retention cyst in the right maxillary sinus. Bone marrow signal characteristics are unremarkable.C-spine:There is a slight reversal of the normal cervical lordosis centered at C5-6, unchanged. Alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. Marrow signal characteristics are benign with evidence of mild likely degenerative endplate marrow edema at C5, C6 and C7.Very slight prominence of the central canal of the spinal cord is seen at the C6 and C7 levels measuring no more than 1 mm in diameter and likely within the limits of normal variation. No other areas of cord signal abnormality are seen.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild posterior disk osteophyte with a small superimposed right paracentral extrusion. The extrusion is smaller than on the prior examination. There is minimal flattening of the ventral cord but no cord signal abnormality. No significant generalized canal stenosis is seen. The foramina are patent. C5-6: Loss of disk height. Posterior disk osteophyte formation slightly asymmetric to the left. Mild spinal canal stenosis with slight ventral cord flattening but no cord signal abnormality. Mild bilateral foraminal narrowing. No significant interval changes. C6-7: Loss of disk height. Posterior disk osteophyte formation without cord impingement or significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No significant interval changes. C7-T1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.
1.Numerous scattered small foci of white matter signal abnormality are seen in a predominantly peripheral and subcortical distribution. The differential for this finding is broad and would include chronic sequelae of migraine, vasculitis, or some other inflammatory process.2.No definite evidence of any active or acute intracranial abnormality is seen. Please note that this examination was not tailored for the evaluation of aneurysms. If such assessment is warranted, an MRA or CTA should be considered.3.Level cervical spondylosis is seen most severely affecting the C5-6 and C6-7 levels where there is loss of disk height, posterior disk osteophyte formation and minimal spinal canal narrowing as above. A small disk extrusion seen at C4-5 on the prior examination has become smaller.