Lower extremity weakness and incontinence MRI brain with contrast: Examination is mildly motion degraded. Postcontrast images of the brain demonstrate no abnormal enhancement associated with the extensive T2/FLAIR signal abnormality in the periventricular and subcortical white matter related to known demyelinating disease. Advanced brain parenchymal volume loss is again noted.MRI cervical spine with contrast: Examination is mildly motion degraded. Postcontrast images demonstrate no abnormal enhancement in the cervical cord to suggest active demyelination. There is patchy T2 signal abnormality in the cervical cord such as at the ventral C3-C4 level but difficult to assess due to motion degradation. Diffuse development narrowing of the cervical spinal canal is again noted with moderate spinal canal stenosis more focally at the C5-C6 and C6-C7 levels related to superimposed central disc protrusions.MRI thoracic spine without and with contrast: Examination is motion degraded however there are no abnormal enhancing lesions or clear evidence of edema in the cord to suggest active demyelinating disease. Areas of patchy T2 signal abnormality are questioned on the axial sequences which are severely limited due to artifact. No definite thoracic lesion on the sagittal sequences is appreciated. Cord parenchymal volume is maintained. Vertebral body heights and alignment of the thoracic spine are maintained. No spinal canal or neural foraminal stenosis is seen.
1. Post contrasted images of the brain demonstrate no abnormal enhancement associated with the extensive white matter signal abnormality related to known demyelinating disease. Advanced brain parenchymal volume loss is again noted.2. Postcontrast images of the cervical and thoracic spine also demonstrate no abnormal enhancement to suggest active demyelination. There is patchy cord signal abnormality particularly in the cervical cord at the ventral C3-C4 level which is suspected to represent a demyelinating plaque.3. Diffuse developmental narrowing of the cervical spinal canal is again seen with up to moderate spinal canal stenosis at the C5-C6 and C6-C7 levels related to superimposed disc protrusions.