Clinical question: Evaluate for progression of MS. Signs and symptoms: Imbalance. Pre- and post enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates interval significant decreased size of several of demyelinating plaques in bilateral cerebral hemispheres since prior exam. There is no convincing evidence of any new demyelinating lesions since prior exam. Multiple previously noted enhancing demyelinating plaques demonstrate significant interval decreased size as detailed above. There is persistent trace enhancement in the left anterior frontal cingulate gyrus similar to prior exam (axial post enhanced series 1101 image 16). There is no associated FLAIR or T2 signal abnormality with this finding which is a similar observation is prior study. This tiny foci of enhancement also has remained stable when compared with earlier exams and including MRI exam from 9-3-2011 and likely representing a tiny developmental venous anomaly.The cortical sulci, ventricular system and CSF spaces are unremarkable for stated age.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.
1.No convincing evidence of new demyelinating plaque or enhancement.2.Significant interval decreased size of multiple previously noted demyelinating lesions and resolution of enhancement.3.Moderate supratentorial findings of chronic demyelinating disease.4.Tiny focus of parenchymal enhancement without associated FLAIR hyperintensity in the left anterior cingulate gyrus has remained stable since multiple prior exams including study from 2011 and likely representing a tiny developmental venous anomaly.