71 years Male (DOB:1/31/1945)Reason: quadriplegia History: as abovePROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG MRI of the brainThere is a large area of diffusion restriction centered in the left parietal lobe with some extension into the postcentral gyrus, posterior aspect of the insular cortex, adjacent occipital lobe and posterior aspect of the left superior temporal gyrus. There is some associated mass effect on the left lateral ventricle and mild midline shift. On susceptibility imaging there is some gyral signal loss associated with this area restriction indicative of petechial blood.Focus of susceptibility effect is present in the left globus pallidus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate some mucosal thickening predominantly in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is elongation of the AP dimension of the eyes bilaterally associated with scleral any.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is hypoplastic. There is fetal origin of the posterior cerebral artery bilaterally with a medium sized left P1 segment and a hypoplastic right P1 segment. There is extracranial origin of the right and left posterior inferior cerebellar arteries. The vertebral arteries are similar in size.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 some straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal. There is some disc desiccation and some right-sided uncovertebral osteophytes at this level with some mild encroachment of the right-sided exiting nerve roots.At C3-4 there is no significant compromise to the spinal canal. There are some endplate uncovertebral osteophytes at this level associated with a disc bulge and some left-sided facet hypertrophy. There is some mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. There is left-sided facet hypertrophy at this level.At C5-6 there is no significant compromise to the spinal canal . There are endplate uncovertebral osteophytes at this level associated with a disc bulge and narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes at this level associated with a disc bulge and narrowing of the neural foramina bilaterally. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level. There is a small central disc protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.Subacute infarction predominantly involving the left parietal lobe but also involving portions of the left insular cortex, temporal lobe and occipital lobe. There is associated petechial blood.2.No evidence for intracranial cerebrovascular occlusive disease.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Staphylomas of the eyes5.There are multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots within the neural foramina at multiple levels as detailed above predominantly including C5-6 bilaterally, left-sided exiting nerve roots at C3-4, left-sided exiting nerve roots at C6-7 and right-sided exiting nerve roots at C2-3.