Relapsing remitting multiple sclerosis. Not on treatment. Tingling in the hands. Brain:Since the previous examination, there has been progression of the patchy and confluent cerebral white matter (including corpus callosum) T2/FLAIR hyperintense lesions. The lesions are larger and more numerous and the overall burden is now moderate-to-severe. Some of the lesions in the frontal lobes are juxtacortical. There are lesions in the cerebellum, cerebellar peduncles, and the brainstem. Increased parenchymal volume loss is seen manifested by increased size of the sulci and other CSF-containing spaces as well as thinning of the the corpus callosum. The orbits are normal. There is minimal mucosal thickening in the inferior aspect of the left maxillary sinus and in the lateral most aspect of the left mastoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. There is no skull destructive lesion.Cervical spine:The T2 hyperintense spinal cord lesions at C1-C2 and C4-C5 levels, as well as several smaller scattered lesion, are not significantly changed since the previous examination. The associated very subtle volume loss at C7 and T1 levels is also unchanged. There is no new cervical spinal cord lesion.Mild multilevel cervical spondylosis has minimally progressed since the previous examination at C2-C3 level and is unchanged at the other levels. There is no significant spinal canal narrowing. There is mild to moderate neural foraminal narrowing as described below.The heterogeneously T2 hyperintense right thyroid lobe nodule is still present but is not diagnostically included.C2-C3: There is mild right neural foraminal narrowing by uncovertebral arthropathy which has slightly increased since the previous examination.C3-C4: There is moderate left and mild right neural foraminal narrowing by uncovertebral and facet arthropathy.C4-C5: There is severe right and minimal left neural foraminal narrowing by uncovertebral and facet arthropathy.C5-C6: There is moderate-to-severe right and moderate left neural foraminal narrowing by uncovertebral and facet arthropathy.C6-C7 and C7-T1: There is no significant spinal canal or neural foraminal narrowing.
1.Since 2012, there has been definite progression in the involvement of the white matter by multiple sclerosis (which is now moderate-to-severe) with more obvious overall volume loss.2.The cervical spinal cord lesions are not significantly changed. 3.The relatively mild multilevel degenerative spondylosis is minimally increased at C2-C3 and is unchanged at other levels.