lower extremity weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are scattered patchy high signal intensity lesion on periventricular white matter as well as infratentorially especially on the right side middle cerebellar peduncle and left side lower medullar on FLAIR images. On Gadolinium enhanced images, there are tubular shaped enhancement on the right trigone area and left periventricular white matter posterior aspect. These enhancements do not show any evidence of associated signal voids or nodular enhancing mass.Considering patient's age, these lesions could represent white matter lesions such as demyelinating disease or age indeterminate but likely chronic ischemic lesions. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Thoracic MRIThere is high signal intensity of spinal cord from T6 and T7 level on T2 weighted image and STIR images. However, there is no evidence of enhancement on post-Gad images.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal. The conus medullaris terminates at the T12-L1 level. Intervertebral discs appear to be normal except some dessication on T10-11 level.
1. Patchy and scattered periventricualr white matter high signal intensity lesions on FLAIR images with a couple of areas of enhancements as well as high signal intensity lesion of spinal cord at the level of T6-7 indicate possibility of demyelinating disease such as multiple sclerosis.2. Non specific small vessel ischemic disease could be associated but less likely.3. Traumatic nature of the spinal cord lesion is also possible but less likely.4. Vascular nature of spinal cord lesion is unlikely