Headaches, paresthesias, reevaluate white matter lesions. Brain: There are least 6 T2/flair hyperintense lesions involving the supratentorial white matter as well as the left thalamus. Many of these lesions demonstrate a morphology and distribution highly suggestive of demyelinating disease. Compared to outside MRI dated 1/13/2015, there is interval development of a new lesion measuring approximately 1 cm in size involving the left posterior callosal body with enhancement. Otherwise no other new lesions or abnormal parenchymal or meningeal enhancement is appreciated. Brain parenchymal volume is preserved. T1 hypointensity associated with some of the lesions is noted including the left periatrial white matter and adjacent to the left temporal horn. There is restricted diffusion associated with the enhancing left posterior callosal body lesion. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: Examination is slightly limited due to patient motion. No abnormal signal however is seen within the cervical cord to suggest demyelinating disease. There is trace prominence of the central canal at the C6-C7 level, which is of doubtful clinical significance. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis at any level in the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Multiple T2/flair hyperintense lesions in the supratentorial white matter with distribution and morphology highly suggestive of demyelinating disease. Compared to 1/13/2015, there is interval development of a new lesion with enhancement involving the left posterior callosal body which is suggestive of active demyelination. Consider further correlation with CSF analysis.2. No T2 hyperintense lesions or abnormal enhancement within the cervical cord is identified. There is trace prominence of the central canal at the C6-C7 level, which is of doubtful clinical significance. 