/13 Date : 00.00.00
Name of the Patient : Abc Xyzlmn / M / 47 yrs.
Referred by : Dr. Abc Xyz Sinh / Dr. Abc Xyzhah.
Examination : M.R.I. of the Cervical and Dorsal
CLINICAL PROFILE :
C/O difficulty in walking with dragging of the left foot since 2 months.
M.R.I of the cervical and dorsal spines was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images in the cervical region
5 mm thick T1 Weighted and T2 Weighted axial images in the dorsal region.
After administration of contrast, the following parameters were used :
4 mm thick T1 Weighted sagittal images.
5 mm thick T1 Weighted axial images.
The lumbar spine was screened with 5 mm thick T1 Weighted sagittal images (pre and post-contrast images).
There is loss of normal cervical lordosis.
- 2 - Scan-00002/13
There is evidence of an area of hyperintensity on the T2 Weighted and Fast Scan (T2 *) images (iso to hypointense to normal cord on the T1 Weighted images) within the cord at the C1/C2 level/cervico-medullary junction. A similar smaller area is noted within the left lateral column at the C3-C4/C4 levels. These lesions do not enhance following contrast administration.
A small right paracentral disc herniation with a peridiscal osteophyte is seen to indent the thecal sac at the C5-C6 level.
A small postero-central disc herniation is noted at the C2-C3 level. Postero-central disc protrusions are noted at the C3-C4 and C4-C5 levels and a peridiscal osteophyte is seen at the C6-C7 level.
The cervical and a few of the dorsal intervertebral discs show loss of water content.
There is no focal area of abnormal enhancement within the spinal cord or in the subarachnoid space on this scan.
The cervical and dorsal vertebral bodies show normal signal intensity. The joints of Luschka and the visualized pre and paravertebral soft tissues are unremarkable.
The visualized dorsal spinal cord shows normal signal intensity.
The atlanto-axial region is unremarkable.
- 3 - Scan-00002/13
The conus medullaris terminates at the L2 level and the thecal sac terminates at the S2 level.
The MRI features are suggestive of altered signal intensity within the cord at the C1/C2 level/cervico-medullary junction and within the left lateral column at the C3-C4/C4 levels and these may represent areas of demyelination (?? ischemic in etiology).