Female 47 years old Reason: MS, f/u progression History: weakness. MRI brain: There is been interval increased number and/or size of scattered as well as confluent areas of T2/FLAIR signal abnormality within the periventricular and subcortical white matter. For example, there has been conspicuous development of a new lesion in the left frontal subcortical white matter on 401/47 as well as one within the right frontal deep white matter on 401/50. There is also a large lesion which is now present in the right aspect of the pons. A right periatrial lesion has increased in extent of central FLAIR hyperintensity compared to prior exam. Many of the lesions oriented perpendicular to the long axis of the lateral ventricles. The majority of the lesions demonstrate corresponding T1 hypointensity. Incidental note is made of a chronic appearing lesion just anterior to the left trigeminal root insertion. There is also a stable lesion in the right cerebellum inferiorly.The ventricles and basal cisterns are prominent for age, consistent with moderate global volume loss greater than expected. There is no midline shift or herniation. There is mild right maxillary and bilateral ethmoid air cell mucosal thickening.MRI C-Spine:There is redemonstration of persistent patchy areas of abnormal T2/STIR hyperintensity throughout cervical cord with associated volume loss, most conspicuously involving the C2, C4-5 and C6-7 levels. There is signal additional abnormality at T1-T2, as previously seen. There are no definite new lesions.The cervical spine is in normal alignment, with reversal of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.
1. Significant progression of intracranial demyelinating disease with multiple new lesions as well as increased size as well as confluence of abnormal signal of previously seen lesions. Both supratentorial and infratentorial disease is identified, including a large new right pontine lesion. Overall, moderate T1 and moderate-severe T2 burden of disease.2. Similar distribution of patchy abnormal signal throughout the visualized cervical and upper thoracic cord with associated areas of volume loss consistent with chronic demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.