Ataxia, tremors; demyelinating disease. Evaluate for progression. Brain: Again seen are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter. There is no significant change compared to 1/19/2015. No new lesions. No lesions with enhancement to suggest active demyelination. Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Evidence of prior left parietal burr hole placement for biopsy with gliosis involving the adjacent cortex again seen. Visualized extracranial soft tissues are unremarkable.Cervical spine: There is minimal patchy T2 signal abnormality throughout the cervical cord without findings to suggest a new discrete lesion. No discrete/large lesion with enhancement is appreciated. There are questionable foci of enhancement such as sagittal post gadolinium series 2201 image 8 and 6 at the C2 level, and axial post gadolinium images 29/44 series 2301 involving the cervical cord at the right C2 level and image 11/44 at the right lateral C6 level.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.
1. Unchanged small scattered T2/FLAIR hyperintense lesions in the white matter. No new lesions or lesions with enhancement to suggest active demyelination.2. Minimal patchy T2 signal throughout the cervical cord is again seen. There are questionable punctate foci of enhancement in the cervical cord as described above which given their small size cannot be definitively corroborated on both the axial and sagittal sequences. These may however suggest active demyelination/inflammation give such appearance on prior studies. Please note and as mentioned previously appearance of these lesions including punctate enhancement are atypical for multiple sclerosis and other inflammatory processes should also be considered.