Female, 79 years old, with clinical findings of stroke. Also with increased muscular tone on the right. Brain:No restricted diffusion is seen. However, extensive patchy white matter T2 hyperintensity is seen involving the high bilateral frontal lobes, the periventricular regions, the anterior temporal tips, and the brainstem. Also noted is extensive prior lacunar ischemia involving the basal ganglia. These findings show little significant interval change from the prior exam.A few scattered foci of susceptibility are seen within the brain indicating prior microscopic hemorrhage. Hemosiderin staining is also seen within the bilateral basal ganglia likely related to prior lacunar ischemia. No acute intracranial hemorrhage is seen and no abnormal extra-axial fluid collections are detected. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss. Postcontrast images show no evidence of pathologic parenchymal or extra-axial enhancement. Loss of the right intracranial vertebral flow void is again seen compatible with occlusion is noted on prior CTA.C-spine:The cervical lordosis is mildly straightened similar to prior. Sagittal alignment is otherwise unremarkable. Degenerative endplate signal alteration is seen at C3, C4, C5 and T1. No concerning marrow replacement is seen.The spinal cord is thinned and T2 hyperintense at C4-5, findings which are relatively similar to the prior examination 2010. Elsewhere, the spinal cord demonstrates normal signal intensityPostcontrast images show no evidence of any pathologic marrow space, epidural, intramedullary or leptomeningeal enhancement.C2-3: Facet hypertrophy, particularly on the left where the facet complex is mildly edematous, progressed from prior. No spinal canal stenosis. Mild left foraminal narrowing similar to prior.C3-4: Ligamentum flavum thickening. Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis without significant interval change. Moderate left and mild right foraminal narrowing, unchanged. C4-5: Left facet hypertrophy and ligamentum flavum thickening, unchanged. Posterior disc-osteophyte complex formation causing a moderate to severe spinal canal stenosis, impingement of the spinal cord, and chronic-appearing cord thinning and T2 hyperintensity. The degree of stenosis and cord impingement is unchanged. Severe bilateral foraminal narrowing, unchanged. C5-6: Ligamentum flavum thickening, unchanged. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing, unchanged. C6-7: Ligamentum flavum thickening, progressed. Left facet hypertrophy, progressed. Mild posterior disc-osteophyte complex formation and uncovertebral hypertrophy, progressed. Mild generalized spinal canal narrowing, progressed, without cord impingement. Severe bilateral foraminal narrowing, progressed from prior. C7-T1: Facet hypertrophy and ligamentum flavum thickening, progressed. No significant spinal canal or foraminal stenosis.
1. No acute intracranial abnormality including no evidence of any acute ischemia.2. Extensive of extensive prior bilateral small vessel and lacunar ischemic disease is seen. This may simply reflect an advanced state of routine small vessel disease. However the pattern of abnormalities is in some ways atypical, and therefore the possibility of some other arteriopathy or vasculopathy, for example CADASIL, may also be entertained.3. Fairly extensive degenerative disease is redemonstrated within the cervical spine. A severe stenosis at C4-5 with chronic cord impingement and myelomalacia is unchanged from prior. Degenerative disease and spinal/foraminal stenoses at other levels have in some cases progressed.