Seizure and encephalopathy, history of lung and pancreatic cancer. Fall, evaluate for ligamentous injury. Brain: There are multiple foci of restricted diffusion involving the cortical surface of the right frontal, left frontal, and left parietal lobes. There is corresponding T2/FLAIR hyperintensity. Relatively larger of these areas of restricted diffusion involves the left inferior parietal lobule cortex. There are innumerable foci of susceptibility effect throughout the bilateral cerebral hemispheres, brainstem, and cerebellum compatible with chronic microhemorrhages. There is a tiny subacute subdural hematoma along the right parietal convexity as seen on recent CT. There are multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease. Chronic lacunar infarct is noted involving the left frontal periventricular white matter.There is no evidence of intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus.Minimal mucosal thickening is seen in the paranasal sinuses. There is opacification of the bilateral mastoid air cells. There is fluid within the nasopharynx. There is edema involving the left occipital scalp which may reflect dependent edema and is nonspecific. Correlate with direct inspection to exclude possibility of associated infection.Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. There are no findings to suggest ligamentous injury. There is minimal fluid involving facet joints at multiple levels which is likely on a degenerative basis. The cervical spinal cord has normal signal characteristics and overall morphology.Some of the sequences are motion degraded slightly limiting evaluation. Multilevel degenerative changes are seen in the cervical spine with disc height loss at the C5-C6, C6-C7, and C7-T1 levels. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc bulge with small central protrusion and ligamentum flavum thickening. There is effacement of the ventral thecal sac. There is overall mild spinal canal narrowing at this level. Minimal neural foraminal narrowing bilaterally C4-5: Mild disc bulge and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C5-6: Disc osteophyte complex with effacement of the ventral thecal sac. Dorsal thecal sac is widely patent without significant spinal canal stenosis at this level. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Mild disc bulge and uncovertebral hypertrophy. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal. Significant loss of disc height. Mild bilateral neural foraminal narrowingThere is mild edema involving the left posterior subcutaneous soft tissues. Paraspinous soft tissue structures are otherwise grossly unremarkable.
1. Multiple small foci of acute to subacute infarct involving the cortex of the right frontal, left frontal, and left parietal lobes. These appear to be in a watershed territory suggesting hypoperfusion injury, although embolic disease remains a less likely possibility.2. Very small subacute right parietal subdural hematoma as seen on recent head CT.3. Innumerable foci of chronic microhemorrhages throughout the cerebral hemispheres, cerebellum, and brainstem. These are of nonspecific etiology, possibly related to coagulopathy.4. No intracranial mass or mass effect to suggest metastatic disease. Please note lack of contrast limits evaluation for small metastatic lesions.5. Edema involving the left parieto-occipital scalp as well as in the subcutaneous tissues of the left neck which may represent dependent edema or possibly posttraumatic. Correlate with direct inspection to exclude possibility of superficial infection in this region.6. No findings to suggest ligamentous injury in the cervical spine. Multilevel degenerative changes in the cervical spine are seen without evidence of high-grade spinal canal stenosis at any level or cord signal abnormality. There is moderate bilateral C5-C6 neural foraminal stenosis. Additional levels as above.