Male, 31 years old, with weakness, history of MS. Evaluate for progression. Brain:Numerous round, oval or linear T2 hyperintense lesions are evident predominantly involving the periventricular and juxtacortical white matter of the cerebral hemispheres. No definite involvement of the brainstem or cerebellum is seen.Since the prior examination, a lesion adjacent to the right occipital horn has decreased in size. In addition, a cortically based lesion within the left anterior frontal lobe has also decreased in size. However, two new lesions are seen within the left frontal lobe, one within the superior frontal white matter, and another large lesion situated in the left frontal white matter nearly spanning between the left frontal horn and the peripheral frontal cortex. Both lesions demonstrate a rim of moderate T2 hyperintensity and a core of marked T2 hyperintensity with marked T1 hypointensity.No significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricles remain normal in size and morphology. Brain parenchymal volume is preserved. The cerebellar tonsils descend below the level of the foramen magnum compatible with Chiari I malformation.Cervical spine:One discrete T2 hyperintense lesion is evident within the anterior aspect of the spinal cord centered at C3-4. Elsewhere, cord shows normal morphology and signal characteristics. No epidural abnormalities are seen.The cervical lordosis is straightened but this is likely positional. Sagittal alignment is unremarkable. Marrow signal characteristics are within normal limits. The intervertebral discs are preserved with no significant compromise of the spinal canal or neural foramina.
1.Numerous lesions are evident within the supratentorial brain compatible with multiple sclerosis. On comparison with the prior examination, two lesions did become smaller. However, two relatively large new lesions also developed.2.A single lesion is identified within the cervical spinal cord which is also compatible with multiple sclerosis. No prior cervical spine imaging is available for comparison.3.Incidental note is made of a Chiari I malformation.