62 years Male (DOB:7/12/1953)Reason: 62 yo M with ETOH abuse, chronic pancreatitis, p/w 6 months of LE weakness, urinary incontinence and FTT History: LE weakness, weight loss, etoh abusePROVIDER/ATTENDING NAME: KEVIN C CONCORDIA CHARLES M WRAY MRI brain: There are T2 and FLAIR hyperintense lesions present within the basal ganglia and thalami. Some patchy T2 and FLAIR hyperintense foci are present in the brainstem. On susceptibility imaging there are multiple punctate foci of signal loss identified in the brainstem, thalami and external capsule on the left. Additional punctate foci of signal loss and susceptibility are identified in the subcortical white matter of the left temporal lobe. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is loss of disc space height, diffuse disc bulge as well as some endplate osteophytes. There is mild right-sided facet hypertrophy at this level. There is effacement of spinal fluid ventral and posterior the spinal cord with overall mild to moderate degree of spinal stenosis. There is ligamentum flavum hypertrophy at this level. There is mild encroachment of the right-sided exiting nerve roots at this level.At C5-6 there is loss of disc space height, disc desiccation, right-sided facet hypertrophy of a moderate degree as well as endplate and uncovertebral osteophytes with narrowing of the neural foramina bilaterally but worse on the right side where there is encroachment of the exiting nerve roots. There is ligamentum flavum hypertrophy at this level. There are some mild spinal stenosis at this level. There are chronic endplate reactive changes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height at this level. There are some subacute endplate reactive changes at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height at this level. There are some subacute endplate reactive changes at this level.The vertebral artery flow voids appear to be intact. The left vertebral artery is smallNo abnormal enhancing lesions are appreciated in the cervical spine.
1.There are multiple lesions in the basal ganglia thalami and brainstem which are suspected to represent prior lacunar infarcts.2.There are multiple microhemorrhages present predominantly in the deep gray nuclei and brainstem was pattern is suggestive of hypertension related microhemorrhages.3.There are degenerative changes present in the cervical spine worse at C4-5 and C5-6 where there is encroachment of the exiting nerve roots on the right side more than the left. There is also mild to moderate spinal stenosis at C4-5 and mild spinal stenosis at C5-6.