 Brain: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. MRA Brain: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. A 2 mm saccular aneurysm is seen in the left cavernous carotid artery (image 59, series 301). No arterial stenoses or occlusions are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Cervical spine: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. No central canal or neural foraminal stenoses.Thoracic spine: There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout.The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. No significant central canal or neural foraminal stenoses.Lumbar spine: There is abnormal signal intensity within the CSF space and appears hypointense on T2 images. This is likely due to pulsation artifact. Widening of the anterior epidural space is seen along the L4-L5 levels. This measures up to 6 mm in thickness and is not fat signal intensity. This is believed to be secondary to engorged venous plexus. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. No significant central canal or neural foraminal stenoses.
1.Widening of the anterior epidural space is seen along the L4-L5 levels. While this is believed to be secondary to an engorged venous plexus, repeat imaging of the lumbar spine with intravenous contrast is recommended to exclude blood products.2.T2 hypointense CSF only on lumbar images is likely secondary to pulsation artifact.3.2mm left cavernous carotid artery aneurysm. No intracranial arteriovascular malformation identified.