Cervical, thoracic, and lumbar radiculopathy on EMG as well as fasciculations, possible ALS. There is a small area of nonexpansile T2 hyperintensity in the dorsal columns and left grey matter of the spinal cord at the C2 level. There is no associated abnormal enhancement. The rest of the spinal cord appears to be unremarkable. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable, aside from a small hemangioma in a mid thoracic vertebral body. There is a disc extrusion at L3-4 that results in moderate to severe spinal canal stenosis. There is also facet hypertrophy and ligamentum flavum thickening at this level, which results in mild to moderate bilateral neural foraminal narrowing. There is a disc protrusion at L4-5 that results in mild spinal canal narrowing. There is also facet hypertrophy and ligamentum flavum thickening at this level, which results in mild bilateral neural foraminal narrowing. There is no significant spinal canal or neural foraminal narrowing at the other lumbar levels or in the cervical and thoracic spine. The paravertebral soft tissues are unremarkable, aside from dependent edema in the posterior lumbar subcutaneous tissues. There is a small left renal cyst. There may be cholelithiasis.
1. Nonspecific lesion involving the dorsal columns and left grey matter of the spinal cord at the C2 level may represent manifestations of ALS. Differential considerations include prior ischemia, trauma, and infection, for example.2. A disc extrusion at L3-4 that results in moderate to severe spinal canal stenosis.3. A disc protrusion at L4-5 that results in mild spinal canal narrowing. 4. Possible cholelithiasis.