R sided tingling, evaluate for TIA MRA of the brain: Normal flow voids through the anterior circulations. There is attenuation of flow-related enhancement of the left proximal P2 segment. There is also focal irregularity of the proximal left posterior communicating artery. Right posterior communicating artery is not well visualized. No evidence of aneurysm.MRA of the neck: Limited evaluation of the arch. Normal flow-voids are seen in the visualized bilateral carotids and vertebral arteries. Bilateral carotid arteries are tortuous. Left vertebral artery is dominant. There is diminutive right V4 segment distal to the PICA origin. Right vertebral artery origin is not well visualized. Origins of the bilateral carotids and left vertebral artery appear patent. No significant steno-occlusive disease.MRI of the cervical spine: There are grade 1 anterolistheses of C3 over C4 and C7 over T1. Vertebral body heights are maintained. There ise multilevel disc desiccation and loss of height. There is developmental narrowing of the spinal canal. There is a lesion with sclerotic margin in the upper odontoid process, which may represent a degenerative cyst or other benign lesion. There appears to be a hemangioma or focal fat deposition at the C6 vertebral body. Otherwise bone marrow signal is unremarkable. Cervical medullary junction is unremarkable with normal position of the cerebral tonsils. Approximately 1.5 cm T2 heterogeneous right thyroid nodule with T2 hypointensity suggestive of blood products and/or calcification. C2-3: There is central disc protrusion and facet arthropathy without significant spinal canal stenosis or foraminal narrowing.C3-4: There is mild uncovering of the disc. There is disc osteophyte complex and uncovertebral arthropathy, right greater than left. There is mild-to-moderate spinal canal stenosis and bilateral moderate to severe foraminal narrowing.C4-5: Disc osteophyte complex with moderate central canal stenosis. There is uncovertebral arthropathy, right greater than left, with moderate-to-severe right and moderate left foraminal narrowing.C5-6: Bilateral uncovertebral arthropathy with moderate-to-severe left and moderate right foraminal narrowing. Disc osteophyte complex with mild-to-moderate central canal stenosis.C6-7: Left uncovertebral arthropathy with mild left foraminal narrowing. No significant spinal canal stenosis or right foraminal narrowing.C7-T1: There is mild uncovering of the disc. No significant spinal canal stenosis or foraminal narrowing.T1-2: Central disc protrusion noted on sagittal view without significant spinal canal stenosis.
1. Attenuation of flow related enhancement in the proximal left P2 segment, consistent with atherosclerotic disease. Otherwise no significant steno-occlusive disease or aneurysm of the intracranial or cervical vasculature.2. Developmental narrowing of the cervical spinal canal with superimposed degenerative changes most prominent at C3-4, C4-5, and C5-6 levels as above, including moderate-severe foraminal narrowings.3. Approximately 1.5 cm right thyroid nodule with blood products and/or mineralization. Ultrasound may be obtained for further evaluation if clinical concern. 