Wk 9, Case 5 - Review

Patient History
54 y.o. male with has a past medical history of HTN (hypertension) who presents with bilateral fingertip numbness and weakness (since he feels like he can't feel them) since yesterday morning. Having a hard time holding objects and tying his shoes.

Findings
Motion degraded examination. The cervical cord is grossly normal in signal and caliber without definite evidence of cord signal abnormality. Possible increased T2 signal on the gradient echo sequences at the C5 level (series 7, image 28) however these are not corroborated on the sagittal STIR sequences and are likely artifactual. Mild reversal of cervical lordosis centered at the C3-C4 level. No significant vertebral body height loss. Mild multilevel disc desiccation is present with uncovertebral degenerative change most pronounced at the C3-4 level. Evaluation of the axial levels demonstrates mild uncovertebral degenerative change at C2-C3 without significant neural foraminal narrowing. At C3-C4, uncovertebral degenerative change combined with right foraminal disc herniation results in severe bilateral neural foraminal narrowing, right greater than left. Minimal thecal sac narrowing. At C4-C5, uncovertebral degenerative change, left greater than right with minimal central disc bulge. Moderate to severe bilateral narrowing, left more than right. Minimal thecal sac narrowing. At C5-C6, uncovertebral degenerative change, left more than right with mild bilateral neural foraminal narrowing. At C6-C7, asymmetric left uncovertebral degenerative change as well as left paracentral and foraminal disc protrusion are present. Severe left and moderate to severe right neural foraminal narrowing. Ligament of flavum hypertrophy is also present resulting in mild thecal sac narrowing with effacement of the ventral and dorsal CSF space. Prevertebral soft tissues are unremarkable. There is a well-circumscribed 1.6 x 1.5 x 1.8 cm T1 and T2 hyperintense cystic structure in the posterior subcutaneous soft tissues at midline at approximately the T1 level, likely a sebaceous/dermoid cyst.

Impressions
Mild motion degraded exam.
1. No evidence of focal cord signal abnormality or cord compression.
2. Degenerative changes with right foraminal disc herniation and severe right foraminal stenosis from uncovertebral joint degenerative change at C3-4. Left foraminal disc herniation with uncovertebral joint degenerative change leading to severe left foraminal stenosis at C6-7.
3. Circumscribed 1.8 cm subcutaneous cystic lesion in the posterior neck at midline at T1 level, likely a epidermoid or sebaceous cyst.