48 years, Male, other malaise and fatigue [780.79] / Disturbance of skin sensation [782.0], Reason for Study: MS? History: Tingling, upgoing toes, eye symptoms Brain: There are approximately 20 T2/FLAIR hyperintense lesions in the supratentorial white matter, many of which are in the periventricular as well as juxtacortical distribution. Few lesions along the callosal surface also seen. No infratentorial lesions in the brain are appreciated. No T1 hypointense lesions/"black holes" are definitively appreciated. Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No evidence of infarct or hemorrhage. No abnormal parenchymal or meningeal enhancement. No extra-axial collections. Ventricles and sulci are within normal limits. Sella and orbits are grossly unremarkable. Calvarium and extracranial soft tissues are unremarkable.Cervical Spine: No abnormal signal seen within the cervical cord to suggest demyelinating disease. Vertebral body heights are normal. Bone marrow signal is benign. There is minimal retrolisthesis of C3 on C4. Alignment of the cervical spine is otherwise maintained. Multilevel degenerative changes are seen with disc osteophyte complexes at C3-C4, C5-C6 and C6-C7 with uncovertebral hypertrophy. There is mild spinal canal stenosis at the C5-C6 and C6-C7 levels. There is mild to moderate C3-C4 neural foraminal stenosis bilaterally related to prominent uncovertebral hypertrophy and disc protrusion. There is also mild to moderate bilateral C5-C6 and mild left C6-C7 neural foraminal stenosis. Thoracic Spine: Apparent punctate T2 hyperintensity seen in the right ventral cord at the T6-T7 level seen on single axial slice is favored to be artifactual. No definite thoracic cord signal abnormality is appreciated. No abnormal enhancement. The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. T1 hyperintense lesion involving the T8 vertebral body is compatible with a hemangioma. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.
1. Approximately 20 T2/FLAIR hyperintense lesions in the supratentorial white matter most of which are in a periventricular and juxtacortical distribution and suspicious for chronic demyelinating disease. No abnormal enhancement to suggest active demyelination. Brain parenchymal volume is preserved.2. No convincing cord signal abnormality is appreciated within the cervical or thoracic cord. No abnormal enhancement.3. Degenerative changes in the cervical spine at the C3-C4, C5-C6, and C6-C7 levels as above with mild to moderate neural foraminal stenosis.