Clinical question: Patient with bilateral upper extremity weakness and recent fall. Rule out hemorrhage/other acute processes. Signs and symptoms: Bilateral upper extremity weakness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for the attention of acute nonhemorrhagic ischemic strokes.Cerebral cortex, cortical sulci and the ventricular system are within normal for patient stated age.The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable. Very small retention cyst in the left maxillary sinus however is present.Nonenhanced cervical CT:There is no detectable bony fracture of the cervical spine.There is very significant degenerative changes of cervical spine with resultant near complete fusion of C3 and C4 , significant loss of intervertebral disk at C4 -- C5 and advanced degenerative changes at C5 -- C6 and C6 -- C7 levels. There is reversal of cervical lordosis centered at C3 there C4. There is highly suspected central spinal stenosis at C3, C4 and C5 levels.There are also bilateral multi-level neural foraminal compromise at C3 there C4, C4 -- C5 and to a lesser degree at C5 -- C6 and C6 -- C7 levels.No detectable paraspinal soft tissue abnormalities.Heavy vascular calcification of the right carotid bifurcation is noted.Enlargement of thyroid lobes with inhomogeneous pattern is concerning for goiter. There is no deviation or compromise of the trachea.
1.Negative nonenhanced head CT.2.No evidence of acute posttraumatic findings of cervical spine. Very advanced degenerative changes of cervical spine with resultant reversal of cervical lordosis and multilevel neural foraminal compromise and suspected central spinal stenosis.