Word finding difficulty and hyperreflexia in the setting of breast cancer. Evaluate for structural cause. BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal cerebral parenchymal volume loss. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL SPINE: There is mild retrolisthesis of C3 on C4 and C5 on C6. There is mild anterior wedging of the C4-C6 vertebral bodies. There is loss of disc height and end plate degenerative changes throughout the cervical spine. The vertebral bone marrow signal is heterogeneous with nonspecific foci of enhancement at the C6-C7 vertebral bodies and C7 and T1 facets and spinous processes. There is mild enhancement of the left paravertebral soft tissues at the level C6-C7.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to mild spinal canal and mild to moderate right and moderate left foraminal stenosis.C4-C5: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to flattening of the left ventral cord, mild to moderate spinal canal and mild right and moderate to severe left foraminal stenosis.C5-C6: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to moderate spinal canal and moderate bilateral foraminal stenosis.C6-C7: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to severe spinal canal and severe bilateral foraminal stenosis. Abnormal T2 signal within the central cord at this level.C7-T1: No significant disc bulge, spinal canal or foraminal stenosis.
1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Advanced degenerative cervical spondylosis with spinal canal stenosis at C3-C4 through C6-7, most severe at C6-C7 with abnormal cord signal and impingement of the cervical cord at this level, which may represent myelomalacia. Variable degrees of neural foraminal stenosis are present at multiple levels of the cervical spine as well.3. Foci of enhancement in the C6-C7 vertebrae, C7 and left T1 posterior elements and left C6-C7 paravertebral soft tissues, which may be neoplastic in nature. A PET-CT may be useful for further evaluation.Findings were conveyed to Dr. Mastrianni by EPIC email on 3/7/2015 at the time of dictation.