Neuro_MR_CTSpine: 65 F, history of ALS, pins and needles feeling weeks after whiplash injury.

MRI CERVICAL AND THORACIC SPINE WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 54 years of age, Female, history of ALS and whiplash injury, presenting with pins-and-needles from the nipple level down, for several weeks, also recent zoster infection in right upper thoracic level, symptoms worsen with neck flexion.

 

FINDINGS:

 

Localizer image: Diffuse muscle atrophy.

 

Alignment: Straightening of the normal cervical lordosis, minimal anterolisthesis of T1 on T2, likely on degenerative basis.

 

Bone marrow: Normal for age.

 

Vertebrae: Multilevel degenerative changes of the cervical and upper thoracic spine manifest by diffuse disc desiccation. Degenerative 

changes are most notable at C5-C6 with loss of intervertebral disc space height and marginal osteophyte formation. Scattered small disc bulges are present. There is mild central canal stenosis in the upper cervical spine at the C1-C2 level primarily on the basis of congenitally short posterior arch of C1, and C3-C4 with disc osteophyte complex effacing the ventral CSF space and slightly flattening the ventral cord.

 

Cord: There is a T2 hyperintense lesion in the upper cervical cord from the C1-C2 to lower C3 level, eccentric to the right, with enhancement of the right lateral aspect (series 32 image 11 and series 31 images 8-9). There is an additional lesion in the thoracic cord from the lower T6 to T7-T8 level, involving primarily the central cord and without definite enhancement postcontrast.

 

Extra-vertebral soft tissues: Diffuse muscle atrophy.

 

Visualized chest: Tracheostomy cannula in place.

 

Additional comment: None.

 

IMPRESSION:

 

1. Enhancing cord lesion of the upper cervical spine from C1-C2 to C3 and nonenhancing central cord lesion at lower T6 to T7-T8. Consider VZV myelitis given recent zoster infection; other considerations include post-infectious and/or post-inflammatory myelitis and demyelinating disorders. MR imaging of the brain may be helpful.

(Transverse myelitis and ALS)