Reason: ms progression History: pain, leg weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular white matter lesions which are bright on T2 and flair sequences as well as lesions extending to the corpus callosum at the callosocingulate junction. Punctate lesions are also present in the right thalamus and left thalamus. Comparing to the previous exam the number and distribution of these lesions has not changed. One in particular along the trigone of the left lateral ventricle is less conspicuous on the current exam when compared to the prior examNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate prolapse of some of the left orbital fat into the maxillary sinus suggestive of a prior left orbital wall which has not changed since the prior exam.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located along the right posterior and lateral aspect of the spinal cord at the C2-3 level which measures 10 mm superior inferior dimension. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located in the left hemicord posteriorly measuring 2 x 5 mm axial dimensions and 9 mm superior inferior length. This is also stable compared with prior exam.There is a 10-mm T1 hyperintense lesion within the T1 vertebral body most likely represent a vertebral body hemangioma.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There are multiple lesions scattered in the supratentorial brain which are relatively stable when compared to prior exam with the exception of a left periventricular white matter lesion adjacent to the trigone of the left lateral ventricle which has regressed since the prior exam. No new lesions are appreciated. This is compatible with patient's clinical history of demyelinating disorder2.There are couple lesions in the cervical spinal cord which are stable since the prior exam and compatible with patient's clinical history of demyelinating disorder.