Date : 00.00.00
Name of the Patient : Abc Xyz Shlmn / F / 18 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
C/O progressive weakness in all four limbs with bladder/bowel involvement since 15 days.
H/O fever with neck swellling on the right side since October 0000 which has increased in size.
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.
Areas of hypointensity on the T1 Weighted images are seen to involve the C5, C6 and C7 vertebral bodies . The C5 and C7 vertebral bodies turn hyperintense on the T2 Weighted images whereas the C6 vertebral body remains hypointense.
There is extension of this pathologic process into the anterior and right lateral epidural space over the C4 to C7 vertebral levels with resultant compression upon the spinal cord. The cord over these levels shows a hyperintense signal on the T2 Weighted images suggesting cord edema/ischemia/myelitis. Also seen is encroachment into the neural foramina bilaterally into the C5-C6 and C6-C7 and on the right side at the C4-C5 and C7-D1 levels with encasement of the exiting corresponding nerve roots. The right pedicles of the C5, C6 and C7 vertebrae appear to be involved.
The pathologic process is also seen to extend into the prevertebral, right paravertebral and right paraspinal soft tissues over the C3 to D1/D2 levels. This soft tissue lesion is hypointense with a hyperintense rim on the T1 Weighted images and turns hyperintense with a hypointense rim on the Fast Scan (T2 *) images and this may represent an abscess (which appears to be loculated).
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The C2-C3 to C5-C6 intervertebral discs show loss of water content. The C6-C7 intervertebral disc is hyperintense on the T2 Weighted images (? involved by the pathologic process).
The rest of cervical vertebral bodies and the remaining intervertebral discs show normal signal intensity. The joints of Luschka are unremarkable.
The atlanto-axial region and the cervico-medullary junction are unremarkable.
The MRI features are suggestive of a pathologic process involving the C5, C6 and C7 vertebrae with soft tissue extensions and cord compression with cord edema/ischemia/myelitis over the C4 to C7 vertebral levels as described.
The differential diagnosis may include infective processes like tuberculosis (more likely) or neoplastic processes like small cell tumors (less likely).