Diagnosis: Multiple sclerosisClinical question: please dom Dr Javed MS protocol, compare to priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular and subcortical white matter lesions within the brain parenchyma which were also present on the prior exam from May 4, 2015.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus which was also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are small foci of T2 signal hyperintensity within the cervical spinal cord centrally and anteriorly at the C3 vertebral body level measuring approximately 3 mm in size along the right posterior lateral aspect of the spinal cord at the T3-4 disc space level, along the left lateral aspect of the spinal cord at the C45 disc space level measuring 3 mm and along the right posterior lateral aspect of the spinal cord at the C6-7 disc space level measuring 2 x 3 mm.. There is an additional lesion present at the T7 T1 level along the right posterior lateral aspect of the spinal cord. None of these are associated with contrast enhancement. Compared to the prior exam 5/13/2015 these lesions are stable.No abnormal enhancing lesions are identified in the cervical spine.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. There is a disc bulge present at this level. This has not changed substantially since the prior exam.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. There is a left lateral recess disc protrusion present at this level which was also present on the prior exam and encroaches on the left-sided exiting nerve roots at the left lateral recess..At C6-7 there is no significant compromise to the spinal canal or neural foramina.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 present in the cervical spinal cord which appears stable when compared to prior exam.2.There are multiple lesions present within the brain parenchyma which appears stable compared to the prior exam.3.There are degenerative changes present in the cervical spine associated with left lateral recess disc protrusion at C5-6 which encroaches on the left-sided exiting nerve root and is stable since the prior exam.