41-year-old female with a history of transverse myelitis, presenting with back pain, numbness/tingling in left leg, imbalance. Assess for demyelination. MRI Brain:Since the prior exam there has been development of multiple new foci of T2/FLAIR signal abnormality in the bilateral subcortical and periventricular white matter, including periventricular lesions perpendicular to the callosum highly suggestive of demyelinating disease. There is no evidence of brain parenchymal enhancement, intracranial hemorrhage, mass, acute infarct, midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI T-Spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is a subtle T2/FLAIR signal abnormality involving the posterior aspect of the spinal cord at the T11-12 level which was present previously. There are no new lesions and no pathological enhancement in the thoracic cord. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.
1.Interval increase in the number of foci of T2/FLAIR signal abnormality in the subcortical and periventricular brain parenchymal white matter including lesions with morphology and distribution highly suspicious for demyelinating disease. 2.Subtle T2/FLAIR signal abnormality within the posterior aspect of the spinal cord at the T11-12 level, most compatible with a chronic demyelinating plaque. No new lesions in the thoracic cord are appreciated.3.No abnormal enhancement in the brain or thoracic cord to suggest active demyelination.