Clinical question: MS, follow-up progression. Signs and symptoms: Paresthesia. Nonenhanced MRI: Minimal findings of demyelinating disease in the posterior fossa involving the left anterior cerebellum, left middle cerebellar peduncle and left aspect of the pons are again identified. Fourth ventricle remains mildly prominent and is stable since prior study. There is new lesion in the right aspect of quadrigeminal plate (R>L).Images through supratentorial space demonstrate significant interval progression of disease in the periventricular white matter of cerebral hemispheres as well as the subcortical white matter and of the corpus callosum. The lesions are slightly more pronounced in the left hemisphere and in particular there is a large left frontal plaque measuring at 17 x 15 mm in transaxial dimensions.There is slight interval progression of supratentorial ventriculomegaly suggestive of ex vacuo dilatation. There is no evidence of mass effect and midline is maintained.Nonenhanced cervical MRI:Examination demonstrate extensive confluent and patchy foci of T2 and T2 STIR hyperintensity throughout the cervical cord consistent with extensive demyelinating disease. There is interval progression of findings and with evidence of foci of decreased cord caliber representing cord volume loss.Normal signal intensity and alignment of vertebral column and without evidence of spinal canal or neural foraminal compromise.Nonenhanced thoracic MRI:This examination also demonstrate extensive findings of demyelinating disease throughout the length of thoracic cord and with suggestion of generalized decreased cord caliber. Compared to prior exam there is suggestion of interval progression of disease.The signal intensity and alignment of vertebral column is unremarkable and without spinal stenosis or neural foraminal compromise.
1.Brain MRI demonstrate interval progression of demyelinating disease both in supra and infratentorial brain parenchyma and with resultant mild further increased supratentorial ventricular size suspected of volume loss.2.Cervical spine MRI demonstrate extensive findings of demyelinating disease with interval progression since prior exam and with evidence of foci of decreased cord caliber.3.Thoracic MRI demonstrate extensive findings of demyelinating disease with generalized decreased cord caliber and with interval progression since prior study. Unremarkable thoracic spine and without spinal stenosis or neural foraminal compromise at any level.