sb/hs/rg/nl
Date : 00.00.00
Name of the Patient : Abc XyzThlmn / M / 22 yrs.
Referred by : Dr. Abc Xyzrges.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE:
C/O numbness in BUE and BLE since 2 years.
EXAMINATION :
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.
OBSERVATION :
There is slight loss of water content of the cervical intervertebral discs.
There are postero-central disc herniations at the C3-C4 and C4-C5 levels indenting the cord anteriorly.
Small postero-central disc herniations are noted at the C5-C6 and C6-C7 levels.
The cervical spinal cord over the C4 and C5 vertebral levels appears slightly smaller in diameter and shows a hyperintense signal on the T2 Weighted and Fast Scan (T2 *) images suggesting cord ischemia/gliosis.
The pedicles of the cervical vertebrae appear congenitally short in their antero-posterior dimensions.
The facet joints at the C3-C4, C4-C5 and C5-C6 levels appear slightly hypertrophied.
The right lobe of the thyroid gland appears slightly larger than the one on the left side.
The C3, C4, C5 and C6 vertebral bodies show a decrease in their height.
The cervical vertebral bodies show normal signal intensity. The joints of Luschka and the visualized pre and paravertebral soft tissues are unremarkable.
The atlanto-axial region and the cervico-medullary junction are unremarkable.
Screening T2 Weighted sagittal images of the dorsal spine reveal postero-central protruded discs in the mid-dorsal region.
IMPRESSION :
1. Postero-central disc herniations at the C3-C4 and C4-C5 levels.
2. Small postero-central disc herniations at the C5-C6 and C6-C7 levels.
3. Altered signal of the cervical cord over C4 and C5
with slight decrease in diameter suggests cord atrophy with cord ischemia/gliosis.
4. Congenitally short pedicles of the cervical vertebrae in their antero-posterior dimensions with cervical canal stenosis at the C3-C4 and C4-C5 levels.
5. Facetal hypertrophy at the C3-C4, C4-C5 and C5-C6 levels.