Clinical question: ?Parkinsons CBD? Signs and Symptoms: tremor L, hyperreflexia L>R, increased tone Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates patchy foci of cystic encephalomalacia only in the periventricular and subcortical white matter of cerebral hemispheres. Findings are nonspecific however considering patients stated age of 74 they likely represent chronic microvascular ischemic changes.Signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.There is a slight generalized prominence of the cortical sulci which is within expected normal range for patient's stated age. Ventricular system remain in normal and the maintained midline.The signal right overall major intracranial arterial branches are identified.Unremarkable images through the orbits. Extensive opacification of the sphenoid sinus consistent with sinusitis and unremarkable other visualized paranasal sinuses and mastoid air cells.Nonenhanced cervical spine MRI:Examination demonstrate normal anatomical alignment the vertebral column however with mildly reversible of cervical lordosis.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate moderate disk disease and loss of disk height. There is mild left neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate moderate disk disease and loss of disk height, minimal facet and ligamentum flavum hypertrophy, mild left neural foraminal compromise and unremarkable otherwise.C6 -- C7 demonstrate moderate disk disease, loss of disk height, minimal ligamentum flavum hypertrophy, mild left neural foraminal stenosis however without spinal stenosis.C7 -- T1 is unremarkable.There is normal signal intensity and caliber of cervical and uppermost visualized thoracic cord at T4 level.
1.Nonenhanced brain MRI demonstrate no acute intracranial process. Moderate chronic nonhemorrhagic small muscle ischemic strokes only in the subcortical and periventricular white matter and unremarkable nonenhanced brain MRI otherwise stated age of 74. Extensive chronic sphenoid sinusitis and unremarkable other paranasal sinuses.2.MRI examination of cervical spine demonstrates mild to moderate degenerative changes with resultant mild reversal of cervical lordosis however without spinal stenosis at any level. Multilevel mild neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of the cord.