Name of the Patient : Abc Xyz lmn / F / 25 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
H/O pulmonary kochs in September 0000. AKT taken for 1 year. Developed cervical lymphadenopathy in October 0000. Cervical lymphadenectomy done. Subsequently developed headaches and abnormal behaviour in March 0000. For follow-up.
M.R.I. of the cervical spine was performed using the following parameters :
5 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
After contrast administration, 5 mm thick T1 Weighted sagittal images in flexion and extension and 5 mm thick T1 Weighted axial images through C1/C2 were obtained.
There is seen an ill-defined, hypointense signal on the T1 Weighted images in the right lateral mass of C1 and left lateral mass of C2. This signal appears hyperintense on the T2 Weighted and Fast Scan (T2 *) images. Minimal soft tissue signal change is noted around the right lateral mass of C1 and within the atlanto-axial joint.
There is atlanto-dens subluxation with the atlanto-dens interval measuring 5.0 mms in the neutral position. The peridental fat shows an ill-defined, hypointense signal on the T1 Weighted images which turns hyperintense on the T2 Weighted and Fast Scan (T2 *) images. On the flexion images, the atlanto-dens interval measures approximately 8.0 mms and on the extension images the atlanto-dens interval is approximately 3.0 mms.
Minimal posterior disc bulges are noted at the C3-C4 and C4-C5 levels.
The rest of the cervical vertebral bodies and intervertebral discs reveal normal signal intensity. The joints of Luschka are unremarkable.
The cervical spinal cord reveals normal signal intensity. There is no cord compression.
The cervico-medullary junction is unremarkable.
After contrast administration, there is patchy enhancement of the pre and paravertebral soft tissues around the right lateral mass of C1 and left lateral mass of C2 and enhancement of the fat around the odontoid process.
1. Altered signal in the right lateral mass of C1 and left lateral mass of C2 represent osteitis, probably tuberculous osteitis with involvement of the atlanto-
2. Altered signal in the soft tissues around the right lateral mass of C1 and in the peridental fat represents soft tissue inflammatory change/granulation tissue.
3. Mobile atlanto-dens subluxation as described.
As compared to the previous MRI (study no:0000) dated 00.00.00, there is reduction in the soft tissue in the prevertebral, left paravertebral and left posterior paraspinal region. Signal change in the right lateral mass of C1 and left lateral mass of C2 may represent resolving osteitis. A mobile, atlanto-dens subluxation is however noted.