Female, 80 years old, with weakness. Evaluate for cord compression. Cervical spine MRI:A longitudinal collection of T2 hyperintense, mildly T1 hyperintense material with rim susceptibility is seen intradurally occupying the right ventral and lateral thecal sac beginning at C1 and continuing down to C4-5. This material, which shows signal characteristics compatible with hemorrhage, appears to contact the spinal cord and causes a posterior and lateral displacement of the cord.The above findings are compounded by the presence of large posterior disc osteophytes in the left paracentral zone at C3-4 and in the right paracentral/foraminal zone at C4-5. The spinal cord is moderately impinged in these areas and seems to demonstrate subtle parenchymal T2 hyperintensity.Straightening of cervical lordosis is seen. Vertebral body heights are grossly preserved allowing for degenerative endplate irregularity. Vertebral body marrow signal characteristics are mildly heterogeneous, but no concerning areas of edema or marrow replacement are demonstrated.C2-3: Thickening of the posterior longitudinal ligament. Right ventral intradural hemorrhage causing displacement of the cord. Otherwise, no significant spinal canal or foraminal stenosis.C3-4: The combination of intradural blood and left paracentral disc osteophyte formation cause a moderate to severe spinal canal stenosis with impingement of the left ventral cord. No significant foraminal narrowing.C4-5: Large right paracentral/foraminal disc osteophyte causing severe narrowing of the right aspect of the spinal cord and flattening of the cord parenchyma. Mild right foraminal narrowing. C5-6: Moderate posterior disc-osteophyte complex formation with mild generalized spinal canal stenosis and moderate to severe bilateral foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation without significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis. The enlarged multinodular thyroid gland is redemonstrated.Cord compression MRI:Evidence of intradural hemorrhage in the cervical region is better described above. Elsewhere, no acute cord compression is seen. The thoracic spine is free of significant stenosis. Multilevel disc degeneration is evident in the lumbar spine with resultant bulging at L2-3 through L4-5. The spinal canal and neural foramina are likely chronically narrowed at these levels.
1.An intradural hematoma is evident in the cervical region occupying the right ventral aspect of the thecal sac beginning at C1 and continuing down to the C4-5 level. This collection exerts some mass effect upon the spinal cord. While this hematoma is clearly intradural, it may be either subdural or subarachnoid in location.2.Superimposed on the hematoma is severe disc osteophyte disease causing further spinal canal stenosis and cord impingement at C3-4 and C4-5. The spinal cord in this area demonstrates possible subtle abnormal signal which could indicate edema or myelomalacia.3.No additional areas of acute cord compression are seen. Advanced degenerative findings are noted in the lumbar region which do likely narrow the spinal canal and neural foramina, but these findings are probably chronic.