 BRAIN: There are numerous, greater than 15, supratentorial nonenhancing white matter T2 hyperintensities lesions in the subcortical and periventricular white matter with involvement of the corpus callosum. While most of these lesions are unchanged, a linear lesion in the left precentral gyrus appears to have increased in size. Many of the lesions demonstrate T1 hypointensity. There is no evidence of acute cerebral infarct or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids appear to be intact.ORBITS: There is no intraorbital signal abnormality, mass lesion, or abnormal enhancement. The optic apparatus appears to be intact. CERVICAL: There are new foci of high T2 signal in the cord posteriorly at C1 and T2-3 level. There is a stable to slight increase in size of the high T2 signal spinal cord lesion at the C2 level posteriorly. However, the lesion in the spinal cord at the C5 level is less conspicuous. There is no pathologic enhancement within the spinal cord. There is a eccentric right disc protrusion and uncovertebral hypertrophy at C5-6 that result in severe right neural foramen stenosis. There is no spinal stenosis or disc herniation at other levels of the cervical spine. There is mild straightening of the cervical spine alignment in the sagittal plane. There are cystic lesions in the midline posterior nasopharynx that measure up to 12 mm, which may represent a Thornwaldt and/or retention cysts.
1.Numerous (greater than 15) supratentorial white matter T2 hyperintense lesions are compatible with demyelination given history of multiple sclerosis. A linear lesion in the left precentral gyrus appear increased from the prior exam, while the other lesions appear to be stable. 2.No detectable lesions involving the optic apparatus.3.Two new demyelinating spinal cord lesions at C1 and T2-3 levels and an unchanged to slightly larger demyelinating lesion at C2 level, but involution of the lesion at C5 level.4.No enhancing demyelinating lesions in the brain or cervical spine.5.New severe right C5-6 neural foraminal stenosis due to right uncovertebral and disc degenerative changes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.