Clinical question: History of multiple sclerosis, RLE weakness, evaluate for burden of disease and positive lesions. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:There are no prior extends for comparison. If such exams exist and are provided the radiology department an addendum to this report will be submitted after comparison.Negative diffusion weighted images.Examination demonstrates extensive periventricular and to a lesser degree subcortical foci of flair hyperintensity of bilateral cerebral hemispheres. Similar signal changes are also noted on flair sagittal series involving the corpus callosum. Findings are associated with moderate enlargement of lateral ventricles, slight prominence of cortical sulci and atrophic changes of corpus callosum. Post-enhanced images demonstrate no detectable abnormal enhancement the brain parenchyma or the meninges.Minimal similar signal changes are also detected at the level of quadrigeminal plate. Although the findings are nonspecific findings and are suggestive of chronic demyelinating disease and less likely chronic small vessel ischemic stroke. No detectable susceptibility signal changes of brain is detected.Signal void in the major intracranial arterial branches are identified.Calvarial and soft tissues of the scalp as well as paranasal sinuses and mastoid air cells remain unremarkable.Pre-and post-enhanced cervical MRI:There is diffuse T2 hyperintensity signal abnormality of the cervical cord extensively. There is however no detectable abnormal enhancement of the cord. There are small regional foci of decreased cord caliber suggestive of atrophy. Findings are highly suggestive of chronic advanced demyelinating disease. The alignment of vertebral column remains within normal. The signal intensity of vertebral column demonstrate changes secondary to degenerative disease and unremarkable otherwise. Degenerative changes results in mild to moderate central spinal stenosis at C4 -- C5 only. Mild neural foraminal compromise at multiple levels is also noted.Pre-and post-enhanced thoracic MRI:Thoracic cord demonstrate multiple foci of T2 hyperintensity with resultant decreased cord caliber/atrophy throughout its length. There is however no evidence of abnormal enhancement of the cord or the leptomeninges. These findings are also highly suggestive of chronic changes of demyelinating disease.Signal intensity and alignment the vertebral column is unremarkable. There is no evidence of spinal stenosis at any level and no convincing evidence of any significant neural foraminal compromise.
1.Brain MRI demonstrate extensive periventricular, subcortical and corpus callosum foci of flair hyperintensity without enhancement and suggestive of chronic demyelinating disease or less likely chronic small vessel ischemic strokes. The findings are associated with underlying parenchymal volume loss as detailed. No prior exams for comparison.2.Pre-and post contrast MRI of the cervical spine demonstrate extensive foci of T2 hyperintensity of the cervical cord without enhancement however with cord volume loss are suggestive of extensive chronic demyelinating disease. Mild degenerative changes of cervical spine results in mild central spinal stenosis at C4 -- C5 level.3.Pre-and post-enhanced MRI of thoracic spine demonstrate extensive patchy foci of cord T2 hyperintensity with underlying cord atrophy and without thickness of enhancement. Findings are highly suggestive of advanced chronic changes of demyelinating disease. No significant degenerative changes of thoracic spine, no central spinal stenosis or neural foraminal compromise.