Clinical question: Having fatigue. Signs and symptoms: New fatigue, cognitive complaints for last few years and blurred vision. Pre-and post enhanced brain MRI:Unremarkable diffusion weighted series. There is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable CT cortex, cortical sulci, ventricular system, CSF spaces and myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses and pattern of enhancement is unremarkable. Calvarium demonstrate a focus marrow signal abnormality in right anterior frontal bone. The lesion measures approximately 16 x 38-mm in transaxial dimensions (axial image 23). It has a thick rim of T2 hypointensity and internal foci of nearly isointense signal which demonstrates enhancement. There is no evidence of edematous changes of the adjacent lateral, no evidence of expansion into the epidural or subcutaneous spaces. The finding is suggestive of a benign lesion such as a calvarial hemangioma or possibly fibrous dysplasia. Follow up with a CT examination is recommended for further assessment.Unremarkable images through the orbits including axial fat sat post enhanced series.Unremarkable images through the sinuses.Pre-and post enhanced cervical MRI:The anatomical alignment the vertebral column is within normal.The signal intensity of vertebral column is unremarkable other than subtle changes secondary to degenerative disease.There is normal signal intensity and caliber all cervical and uppermost visualized thoracic cord.There is no detectable concerning abnormal enhancement the vertebral column, cord or the leptomeninges.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild asymmetric left-sided facet hypertrophy with resultant mild left neural foraminal compromise.C4 -- C5 demonstrate mild degenerative changes and unremarkable otherwise.C5 -- C6 demonstrate mild disk disease and loss of disk height and minimal hypertrophic changes of posterior elements. There is moderate to severe right neural foraminal compromise. Minimal left neural foramina compromise and no central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum hypertrophy. There is a right-sided disk osteophyte complex with several effacement of ventral subarachnoid space, moderate to severe right neural foraminal compromise and no central spinal stenosis.C7 -- T1 is unremarkable.
1.Pre-and post enhanced brain MRI demonstrate no detectable intracranial abnormalities. There is a well demarcated right frontal skull lesion with a thick rim of T2 hypointensity and with central focus of enhancement measuring approximately at 16 x 38-mm. Finding is suggestive of a benign lesion such as a fibrous dysplasia or a hemangioma. Recommend follow-up with CT examination is recommended.2.Pre-and post enhanced MRI of the cervical spine demonstrate mild degenerative with resultant pain severe right and mild left neural foraminal compromise at C5 -- C6, moderate to severe right neural foraminal compromise at C6 -- C7 however without central spinal stenosis at any level. Unremarkable exam otherwise.