60 years Male (DOB: 3/14/1956)Reason: 60F with h/o MS, neuro c/s service requesting MRI Javed protocol to further assess History: diffuse pain, joint contractures, poor appetitePROVIDER NAME: IRSK J ANDERSON IRSK J ANDERSON MRI brain:There is a moderate degree of periventricular white matter lesions present associated with some volume loss. These are perpendicularly oriented to the lateral ventricles. They are hyperintense on T2 and FLAIR and hypointense on T1. There is no associated contrast enhancement. Additional similar appearing punctate lesions are identified in the brainstem, left cerebellar hemisphere and subcortical white matter.There is a small focus of encephalomalacia involving the right inferior parietal lobule and postcentral gyrus which involves a portion of the right supramarginal gyrus. Another small focus of encephalomalacia is present along the left temporal lobe posteriorly.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery flow-void is smaller than the right vertebral artery flow-void. This is nonspecific.The visualized portions of the paranasal sinuses demonstrate scattered opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is an old left-sided medial blowout fracture present.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a vague signal hyperintensity within the spinal cord at the C2-3 level. No abnormal enhancing lesions are identified in the cervical spine. There is reversal of the normal cervical curvature presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc protrusion at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes at this level which are worse on the right side where there is some encroachment on the right-sided exiting nerve roots..At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There are multiple periventricular, subcortical, brainstem and cerebellar lesions present which are compatible patient's clinical diagnosis of demyelinating disorder. There is no abnormal enhancing lesion within the brain parenchyma to suggest acute plaque formation.2.There is a vague spinal cord lesion present at the C2-3 level. One possibility is that this represents a demyelinating lesion.3.There are small foci of encephalomalacia identified in the right parietal lobe and left temporal lobe as detailed above which are of unknown cause. Is possible they are vascular related or related to other injury.4.There are degenerative changes present in the cervical spine worse at C5-6 where there is some encroachment of the right-sided exiting nerve roots due to osteophytes.