25 years old female with history of narcolepsy came with chief complaint of word finding difficulty and bilateral hand numbness. Patient found to be hyperreflexic on neuro-exam. Rule out multiple sclerosis. Brain:The brain shows no focal lesion. Dilated perivascular spaces are present in the frontal white matter. There is also an incidental right frontal developmental venous anomaly which is a normal variant, of no clinical significance. The dural venous sinuses and the major intracranial arteries are patent. The ventricles and the other CSF-containing spaces are also normal in size. There is no abnormal enhancement.There is left more than right temporomandibular joint osteoarthrosis associated with synovial contrast enhancement and thickening. This is also associated with erosions and joint space loss.Cervical Spine:Cervical spinal alignment is notable for straightening which may reflect patient position. The vertebral bodies are preserved in height. The marrow signal is normal. There is minimal disc T2 signal loss from C2-C3 through C5-C6. The disc heights are fairly preserved. The spinal canal is not significantly narrowed. The spinal cord has normal morphology and signal. There is no abnormal spinal cord, leptomeningeal or nerve root contrast enhancement.C2-C3 and C3-C4: There is no spinal canal or neural foraminal narrowing.C4-C5, C5-C6 and C6-C7: There are shallow, insignificant anterior indentations of the thecal sac by degenerative dense. There is no neural foraminal narrowing. C7-T1: There is no spinal canal or foraminal stenosis.
1.Normal brain examination.2.Normal cervical spinal cord.3.Minimal cervical spondylosis without nerve or spinal cord compression.4.Left more than right temporomandibular joint osteoarthrosis, significantly advanced for age. Please correlate clinically.