Reason: Evaluate for spinal cord pathology to explain diffuse hyperreflexia and some leg weakness History: Episodes of non rhythmic tremor; hyperreflexia, wheelchair MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a developmental venous anomaly present along the posterior aspect of the left temporal lobe and adjacent left inferior parietal lobule. This is associated with a ringlike low signal lesion left central T2 hyperintensity measuring 10 x 10 mm axial dimensions adjacent to the left lateral ventricle near the trigone.There is some abnormal signal associated with contrast enhancement along the subcutaneous and cutaneous tissues along the left for head. This associated with an underlying venous structure which appears to extend to the calvarium.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. 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 no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a small right paramedian disk protrusion present at T7-T8 and to some multilevel disk desiccation.
1.There is a 10mm cavernous malformation present adjacent to the trigone of the left lateral ventricle which is associated with a developmental venous anomaly.2.There are mild degenerative changes present in the thoracic spine.3.No abnormal lesions are appreciated within the cervical or thoracic spinal cord. If there is clinical suspicion for leptomeningeal disease.4.There is a left for head lesion present. Please correlate with physical findings on clinical exam