67-year-old male with history of multiple sclerosis experiencing left-sided weakness. Brain MRI:Restricted diffusion with ADC hypointensity within the left cerebellar hemisphere correlates with previously identified increased hypoattenuation within the left cerebellar hemisphere. To a lesser extent, there are a few small foci of restricted diffusion with ADC hypointensity within the right cerebellar hemisphere and vermis. This is associated with some folio effacement on the left, T2 hyperintensity,T1 hypointensity, and a minimal degree of enhancement. This constellation of findings is consistent with subacute infarction. Previously identified supratentorial restricted diffusion in 2012 has resolved.Redemonstrated is T2 hyperintensity within the white matter, confluent in many locations, without associated mass effect correlating with previous hypodense abnormality on CT. There is no associated enhancement. Encephalomalacia in the right parietal lobe and right frontal lobe from prior remote infarct is noted. Prominence of the right sylvian fissure is again noted as identified on the recent head CT, correlating with evolution of the restricted diffusion identified on the 2012 MRI.Mucosal thickening is again noted within the left maxillary sinus. Expected vascular flow-voids are demonstrated, including the distal bilateral vertebral arteries and basilar artery.Cervical spine MRI:Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.There are no fractures. The marrow signal is benign. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild posterior osteophyte disc complex, ligamentum flavum thickening, left uncinate hypertrophy, and left facet hypertrophy. There is moderate left neural foraminal stenosis.C3/4: Trace retrolisthesis C3 on C4, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and left facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and minimal left facet hypertrophy. There is minimal central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, left uncinate hypertrophy, and ligamentum flavum thickening. There is moderate left neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex without significant stenosis.
1.Findings consistent with subacute infarction involving the cerebellar hemispheres (left greater than right) and vermis.2.Redemonstrated is extensive T2 abnormality within the supratentorial white matter, none of which enhances. Some of this correlates with previously identified foci of ischemia. However, the findings most likely represent a confluence of the patient's known multiple sclerosis and superimposed vascular disease.3.Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.4.C2/3: Moderate left neural foraminal stenosis.5.C3/4: Mild central and severe bilateral neural foraminal stenosis.6.C4/5: Minimal central and severe bilateral neural foraminal stenosis.7.C5/6: Severe bilateral neural foraminal stenosis.8.C6/7: Moderate left neural foraminal stenosis.