Multiple sclerosis [G35], Reason for Study: ^Reason: please evaluate MS lesion burden and r/o old lesions History: 57yof with MS for 29y presenting with acute worsening of old MS symptoms of rt spasticity and severe intention tremor Brain MRIThere are multiple various sized FLAIR/T2 high signal intensity lesions especially around bilateral periventricular white matter and centrum semiovale which are consistent with demyelinating disease.Those lesions, however, do not show any evidence of contrast enhancement.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, restricted diffusion/acute ischemia, or abnormal contrast enhancement. 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.C spine MRIThe spinal cord signal intensity is normal.There is no evidence of abnormal enhancement.Cervical spine appears to be straightened, however, the spine alignment is anatomic.Vertebral height is preserved.There are minimal bulging of discs at the level of C45 and C56, without evidence of thecal sac compression or spinal canal stenosis.There is no evidence of cervical spinal neuroforaminal narrowing.
1. Multifocal bihemispheric various sized periventricular and centrum semiovale demyelinating lesions consistent with known multiple sclerosis.2. There is no evidence of abnormal enhancement.3. No evidence of spinal cord lesion.4. No evidence of acute ischemic or hemorrhagic lesion.