ke/bv/nl/rg.
Name of the Patient : Abc Xyza Sullmn / M / 44 yrs.
Referred by : Dr. Abc Xyzrankar.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
C/O weakness of BUE and BLE since 8-10 days.
EXAMINATION :
M.R.I of the cervical spine 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.
OBSERVATION :
There is replacement of the normal marrow of the C4 and C5 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogenously hyperintense on the T2 Weighted images. The C4-C5 intervertebral disc is involved by the pathology with erosion of the adjacent cortical endplates. Pre and paravertebral soft tissue extension is noted over the C2-C3 to C5-C6 levels which is slightly hyperintense to muscle on the T1 Weighted images and turns hyperintense on the T2 Weighted images and would represent granulation tissue/abscess. The anterior longitudinal ligament is elevated. A large anterior epidural extension is seen at the C4 and C5 vertebral levels with posterior displacement and compression of the spinal cord at these levels. The spinal cord at these levels show a hyperintense signal on the T2 Weighted and Fast Scan (T2 *) images which is isointense to cord on the T1 Weighted images and would represent cord edema/ischemia.
A postero-central disc herniation with peridiscal osteophytes is seen at the C3-C4 level with anterior indentation of the thecal sac. The rest of the cervical intervertebral discs show loss of water content.
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A small postero-central disc protrusion is noted at the C2-C3 level.
Spotty fatty marrow changes are seen in the C2 and C3 vertebral bodies.
The rest of the cervical vertebral bodies show normal signal intensity. The joints of Luschka are unremarkable.
The atlanto-axial region and the cervico-medullary junction are unremarkable.
IMPRESSION :
The MRI features are suggestive of altered signal intensity in the C4 and C5 vertebral bodies with pre, paravertebral and epidural extension as described with cord edema/ischemia at the C4 and C5 levels is probably due to a granulomatous infective process like tuberculosis.
The possibility of this being a neoplastic process is considered less likely.