Male, 38 years old, with multiple sclerosis presenting with numbness and weakness. C-spine:Mild prominence of the central canal of the spinal cord is seen from the level of the obex to C2. The caliber of the canal never measures more than 1 mm which is within the limits of normal variation.Since the prior examination, extensive central cord T2 hyperintensity spanning from C2 through C7 has significantly improved. All that remains of this prior abnormality are two longitudinal tracts of T2 hyperintensity within the central gray of the cord bilaterally spanning the C5 and C6 levels. Elsewhere no new areas of pathologic cord signal are seen. No pathologic cord or leptomeningeal enhancement is seen.Straightening of the cervical lordosis is likely positional. Vertebral body height and morphology are normal. No pathologic marrow signal abnormality is seen.No significant spinal canal or neuroforaminal stenosis is evident at any level. Mild posterior disc-osteophyte complex formation is seen at C5-6.Brain:Several punctate foci of T2 hyperintensity are seen within the right frontal subcortical white matter. Accounting for differences in technique, these seem to have been present on the prior examination and have not significantly changed.A small focus of T2 hyperintensity is evident along the left frontal horn, and another along the body of the right lateral ventricle, both of which also seem to have been present previously.No evidence of parenchymal edema, mass effect or midline shift is seen. No restricted diffusion is demonstrated. No pathologic enhancement is seen. A small right frontal developmental venous anomaly is seen.Incidental note is made of ectopia of the right cerebellar tonsil, a stable finding.Extensive ethmoid and maxillary sinus mucosal inflammation is demonstrated, a new finding from the prior exam.
1.Several scattered punctate lesions are demonstrated in the cerebral hemispheres without significant or convincing interval change. Although two of these are along the ventricular margin, they are ultimately nonspecific in morphology.2.Longitudinally extensive signal abnormality seen previously within the cervical spinal cord has significantly improved. Only two small tracts of T2 hyperintensity persist at the C5-6 level.3.The above described brain and cord findings are not entirely typical for multiple sclerosis. Particularly, the previously seen longitudinally extensive central cord signal abnormality would be an unusual finding in multiple sclerosis. Neuromyelitis optica does remain within the differential based on imaging findings. Likewise, other inflammatory, postinfectious and autoimmune etiologies may also be considered.4.Stable ectopia of the right cerebellar tonsil.5.New paranasal sinus inflammatory disease.