37 years, Female, multiple sclerosis, follow-up for progression. Weakness of arms and legs. BRAIN: Compared to 4/3/2015, there is interval development of a new T2 hyperintense lesions in the brain, one of which involves the left precentral gyrus near the junction with the left middle frontal gyrus and one which involves the dorsal aspect of the lower medulla in the midline/paramedian region extending to the cervicomedullary junction. These two new lesions demonstrated enhancement.Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are again noted and consistent with known demyelinating disease. Additional infratentorial lesions including the right middle cerebellar peduncle and the left cerebellar hemisphere are again seen. Brain parenchymal volume is maintained. Few lesions with T1 hypointensity are also noted.No intracranial mass or mass effect. No midline shift, hydrocephalus, or herniation. Calvarium and extracranial soft tissue structures are grossly unremarkable.CERVICAL SPINE: There is a new T2 hyperintense lesion involving the cervicomedullary junction with enhancement as mentioned above. There are tiny T2 hyperintense lesions involving the bilateral ventrolateral aspects of the cervical cord at the C4-C5 level. These lesions are evident on the axial T2, axial mFFE, and STIR sequences and more subtle on the prior study. There is a questionable additional T2 hyperintense lesion involving the cervical cord at the C7 level. No abnormal enhancement is appreciated.Partially imaged thoracic cord demonstrates a T2 hyperintense lesion in the ventral cord at the T1-T2 level, which appears to be present on prior although better seen on current study.Vertebral body heights are normal. There is mild reversal of cervical lordosis. Alignment is otherwise maintained. There is no significant spinal canal or neural foraminal stenosis at any level. Scattered perineural cysts are incidentally noted in the neural foramina.
1. Multiple supra- and infratentorial T2 hyperintense lesions consistent with known demyelinating disease. Compared to MRI brain dated 4/3/2015, there is interval development of two new lesions involving the left frontal lobe and cervicomedullary junction. These lesions demonstrate enhancement. Findings are consistent with progression of disease with areas of active demyelination.2. There are small T2 hyperintense lesions in the cervical cord at the C4-C5 level and partially imaged upper thoracic cord, which were present previously. Aside from the cervicomedullary junction lesion mentioned above, no new lesions or lesions with enhancement in the cervical cord are appreciated.