Left cranial nerve VI and VII pulse, known multiple sclerosis patient. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered variable sized high signal intensities on FLAIR imaging are identified including left temporal lobe anterior aspect bilateral trigone areas, periventricular white matter, left precentral gyrus, right midbrain posterior aspect, bilateral middle cerebellar peduncles, and left mid to lower pons. These high signal intensity lesions are compatible with multiple sclerosis plaque.Especially the left mid to lower pons and left side middle cerebellar peduncle and left anterior temporal lobe lesions demonstrate periportal irregularity shaped contrast enhancement indicating minimal effective multiple sclerosis plaque. The differential diagnosis of these lesions include high-grade glioma or metastasis but those possibility would be lower.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRI:Multifocal patch high signal intensities on T2 and STIR images were seen on craniocervical junction to the cervical spine. On axial scan, abnormal high signal intensity lesions involve bilateral posterolateral aspect of spinal cord at the level of C1, the lesion involves the central portion of the spinal cord as well. Again, the location and characteristics of this high signal intensity lesions are consistent with multiple sclerosis involvement of the cervical spine.There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: Disc desiccation no spinal stenosis. Minimal left neural foraminal narrowing. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: Minimal thickening of the ligamentum flavum, otherwise no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.
1. Multifocal patch high signal intensities on FLAIR imaging as described above, consistent with multiple sclerosis plaque.2. Irregular walled enhancing lesions especially on the left temporal lobe anterior aspect as well as left-sided mid to lower pons and the left middle cerebellar peduncle suggestive possibility of tumefactive multiple sclerosis lesions. Differential diagnosis includes high-grade glioma in metastatic lesions, but the possibility is low.3. Multifocal patch high signal intensity lesions on T2 and STIR images on all cervical spine consistent with multiple sclerosis involvement of C-spine.