Brain MRI:
The exam was performed pre and post administration of 16mL of IV Magnevist gadolinium.
Findings: There is evidence suggestive of generalized meningeal enhancement away from the ventricles; ependymal enhancement is not observed; warrants consideration and differential consideration per below.
There are high-signal foci, numerous, towards the outer margins of the cortical white matter junctions in the parietal and junctional white matter levels diffusely with the most prominent focal area in the towards the left posterior parietal region; a microvascular ischemic pattern though not excluded; correlation as to potential relationship to the known hepatitis, Lymes disease, sarcoid, lupus, leukemia or other white matter entities; pattern is not supportive of the distribution of MS; other inflammatory infectious or infiltrative diseases all warrant consideration; the infratentorial region, middle and posterior cranial fossa, the infratentorial region, middle and posterior cranial fossa, the orbital/paraorbital regions are unremarkable.
The ventricular and subarachnoid spaces are small; generalized small character throughout that may be of an incidental character; potential relationship to the disease process warrants consideration only.
The remainder of the intracranial pattern, the venous and arterial vascular regions, the sella and contents, the CP angles and the located cerebellar tonsils are grossly without additional findings.
Diffuse mucosal thickening moderate in the right maxillary sinus with a mucus collection dependent posteriorly; probably active and chronic sinusitis localized; the other paranasal sinuses and the nasal passages are unremarkable.
IMPRESSION:
1. Concern for peripheral meningeal enhancement and prominent cortical white matter junction disease supratentorial at the parietal and junctional white matter levels; indeterminate as to etiology.
2. Mucosal disease, prominent thickening and dependent mucus evident right maxillary level.
MR-Cervical Spine Without Contrast
Findings:
At C5-6 there is limited to mild disc protrusion posteriorly with a slight dehydrated annular tear with resultant moderately broad based effacement of the anterior thecal sac; central canal is nonstenotic without gross evidence of cord or root affects; slight abutment of the ventral C6 roots could not be excluded , again the canal is nonstenotic at 10.5mm minimum AP diameter centrally.
At C6-C7 slight bulged annulus posteriorly, slight disc dehydrations without encroachment concerns.
At C3-4 and C4-5 very slight bulged annulus posteriorly, slight disc dehydrations without encroachment concerns.
From the base of the skull through C2-3 and from C7-T1 through T4-5 there are no additional concerns.
Limited gradual multimodal scoliosis is evident with slight straightening through the proximal to mid cervical region.
Impression:
1. At C5-6 despite limited to mild disc protrusion posteriorly slight effacement without evidence of canal stenosis; question of slight abutment of the ventral C6 roots; correlation.
2. Slight spondylosis C3-4, C5-6 and slightly more bulged annulus posteriorly at C6-7 without encroachment concerns; overall pattern related to limited gradual multimodal scoliosis.
