Female, 57 years old, with multiple sclerosis and worsening weakness. Assess for MS lesions and meningioma. Brain:Numerous T2 hyperintense lesions are seen prominently within the periventricular white matter but also to a lesser degree in the juxtacortical white matter and the brainstem. Several of these lesions show evidence of enhancement including two lesions along the left lateral ventricle, a lesion in the left lower parietal lobe, a lesion in the right parietal lobe, a lesion along the posterior medial right temporal lobe, and lesions in the brainstem.Evidence of frontal craniotomy is seen with encephalomalacia and gliosis of the left orbital gyri. A fairly homogeneously enhancing mass is present centered within the left suprasellar cistern measuring up to 28 x 17 mm in the axial plane and up to 16 mm craniocaudally. The lesion probably invades the left cavernous sinus and partially encases the left ICA. It also projects into the prepontine cistern and contacts the basilar artery. The lesion encroaches upon the sella and exerts mass effect upon the pituitary gland and pituitary stalk. The left optic nerve and chiasm are not clearly visualized and may be embedded within the tumor.No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. A focus of susceptibility within the left cerebellum without edema is compatible with chronic microhemorrhage. Generalized parenchymal volume loss is seen with prominent sulci and ventricles. A focally prominent CSF space along the right parietal lobe may represent an arachnoid cyst.C-spine:Multiple T2 hyperintense lesions are seen within the spinal cord including anteriorly at the cervico medullary junction, centrally and left laterally at C2, left laterally at C3-4, left laterally at C5-6 and anteriorly at C7. As assessed on sagittal images, several additional lesions are seen in the thoracic region. None of these lesions shows definite corresponding enhancement.The cervical lordosis is reversed but spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality or enhancement is seen.C2-3: Right uncovertebral hypertrophy. Minimal right foraminal narrowing. C3-4: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet hypertrophy on the right. Posterior disc-osteophyte complex formation with a large component in the right paracentral region. This causes effacement of the ventral thecal sac and some flattening of the ventral cord with a mild generalized spinal canal stenosis. Mild right foraminal narrowing. C6-7: Right facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C7-T1: Unremarkable.
1.Numerous white matter lesions are evident within the brain compatible with the diagnosis of multiple sclerosis. Several of these lesions show evidence of enhancement compatible with active inflammation.2.A left suprasellar mass is again seen compatible with history of meningioma. This lesion likely invades the left cavernous sinus and at least partially encases the left ICA. The lesion exerts mass effect upon the pituitary gland and pituitary stalk. The left optic nerve and chiasm may be embedded within the lesion. Sequelae of left frontal approach surgery are seen perhaps related to this lesion.3.Multiple lesions are evident within the cervical and partially visualized thoracic spinal cord, but without clear evidence of enhancement.4.Degenerative disc disease is seen most severely affecting the C5-6 level where there is a right paracentral disc osteophyte which mildly impinges upon the cord.