MRI cervical spine shows reversal of cervical lordosis and posterior disc bulges at C3-4, C4-5, and C5-6 levels indenting the anterior subarachnoid space and affecting bilateral exiting nerve roots. The dorsal spine is essentially normal. The lumbar spine shows mild posterior disc bulges at L3-4, L4-5, and L5-S1 indenting the thecal sac with fatty end plate changes.
MRI Brain reveals cerebral and cerebellar atrophy, bilateral periventricular ischaemia, and chronic small vessel ischaemic changes. These can contribute to unsteadiness, imbalance, and episodic confusion/disorientation, especially in the absence of focal cord compression or acute brain insult.
Overall, the imaging supports a chronic degenerative process involving both the spine (multilevel spondylosis/disc bulges) and the brain (age-related atrophy and ischaemic changes). The acute worsening of balance and intermittent confusion may be multifactorial: a combination of cervical nerve root involvement, possible mild cord compromise due to disc bulges, and chronic small vessel disease of the brain affecting gait and cognition.
Next Steps
Urgent neurology consultation is recommended to assess for possible subacute myelopathy, cerebellar dysfunction, or vascular events contributing to symptoms.
Clinical evaluation for gait, cerebellar, and cranial nerve function should be performed to rule out cord or brainstem involvement.
Fall precautions and supervised ambulation are advised until stability improves to prevent further injuries.
Optimize management of vascular risk factors (blood pressure,
diabetes, lipids) given the chronic ischaemic brain changes.
Review with specialist for potential physical therapy, neuro-rehabilitation, and pain management for discogenic symptoms
Health Tips
Sudden worsening of gait and imbalance after recent fall, in the context of chronic cervical and brain changes, should not be ignored—possibility of evolving neurological deficit must be promptly excluded.
Watch for any further decrease in limb power, persistent confusion, new-onset bladder/bowel symptoms, or severe headache/seizures—these require immediate medical attention.
Regular follow-up and imaging may be needed to monitor progression of both spinal and cerebral degenerative changes.