Male, 58 years old, with right-sided weakness. Assess for stroke or lesion. Brain:No evidence of restricted diffusion is seen. Numerous small foci of T2 hyperintensity are demonstrated within the subcortical and periventricular white matter of the cerebral hemispheres. Prominent patchy T2 hyperintensity is evident within the central pons.No evidence of parenchymal edema or mass effect is detected. On postcontrast images, there is no pathologic parenchymal or extra-axial enhancement. A small developmental venous anomaly is evident within the left precentral gyrus.No findings are seen to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology.Lumbar spine:Grade 1 retrolisthesis of L4 relative to L5 is demonstrated. Spinal alignment is otherwise unremarkable.Marrow signal characteristics are heterogeneous with evidence of predominantly fatty signal alteration involving the upper half of S1, the entirety of L5, most of the bottom portion of L4, and a small portion of the anterior/inferior endplates of L3 and L2. These areas partially suppressed on STIR images which suggests the presence of some edema in addition to fatty change.Degenerative disease is evident at every level, though it is most severe at L4-5 and L5-S1 where there is near complete loss of disk height and substantial signal change in the adjacent marrow which is also likely degenerative. Level specific findings are as follows:L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Mild to moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk and prominent dorsal epidural fat contribute to a moderate spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk and prominent dorsal epidural fat contribute to a mild to moderate spinal canal stenosis with slight crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L4-5: Moderate to severe facet hypertrophy and ligamentum flavum thickening. Markedly bulging disk with a superimposed right paracentral protrusion. The entire left aspect of the spinal canal is occupied by globular, markedly T1/T2 hypointense material which fills the spinal canal from the L4-5 disk level up to the midportion of the L4 vertebral body. Resulting severe spinal canal stenosis at this level with marked impingement of the cauda equina. Severe bilateral foraminal narrowing, worse on the right. L5-S1: Severe facet hypertrophy and ligamentum flavum thickening. Markedly bulging disk. Mild to moderate spinal canal stenosis. Severe bilateral foraminal narrowing, worse on the right.
1. No acute intracranial abnormalities. Scattered small foci of signal abnormality are demonstrated in the cerebral white matter with prominent signal abnormality in the pons. These findings could represent chronic microvascular ischemic disease, particularly if there are clinical risk factors. Otherwise, prominent involvement of the pons could also reflect demyelination, osmotic demyelination or a prior metabolic insult.2. Severe degenerative disease in the lumbar spine particularly affecting L4-5 and L5-S1 where complete loss of disk height and severe degenerative marrow signal abnormalities are seen.3. At L4-5, there is a bulging disk with right paracentral protrusion. In addition, a globular region of markedly T1/T2 hypointense material occupies the left half of the spinal canal from the level of the disk space up to the midportion of the L4 vertebral body. This material could represent a desiccated or calcified sequestered disk, dense fibrosis, or dystrophic calcification of some other cause. A severe spinal canal stenosis results at this level with marked impingement of the cauda equina nerve roots.4. Less severe spinal canal stenosis is demonstrated at L2-3, L3-4 and L5-S1. Severe foraminal narrowing is evident at L4-5 and L5-S1, particularly on the right.