43 years Female (DOB: 9/24/1972)Reason: MS, eval for progression History: paresthesiasPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion, a left thalamus lesion and a right deep cerebellar lesion which are bright on FLAIR MRI and low signal on T1 that are smaller on the current exam compared to the prior exam. There is T2 signal hyperintense lesion present at the junction of medulla and spinal cord. This has not changed relative to the prior exam.The visualized portions of the paranasal sinuses are clear. 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 is T2 signal hyperintense lesion present at the junction of medulla and spinal cord. This has not changed relative to the prior exam.Foci of signal hyperintensity are present along the cervical spinal cord at the C2 vertebral body level measuring 9 mm by 5 mm sagittal dimensions, another located posteriorly at the C2-3 level measuring 4 mm axial dimensions along the left posterolateral aspect of the spinal cord which appears to have regressed relative to the prior exam. Additional smaller lesion is present in the left hemicord at C4 which is stable. Focal signal hyperintensity is also present along the thoracic spinal cord at the T1-2 level measuring 7 mm x 4 mm sagittal dimensions which is stable.At C2-3 there is a small central disk protrusion without significant compromise of spinal canal or exiting nerve rootsAt C3-4 there is redemonstration of a small central disk extrusion which compresses the thecal sac and effaces spinal fluid ventral to the spinal cord and is associated with flattening of the spinal cord. This has regressed relative to the prior exam.At C4-5 there is a diffuse disc bulge at this level associated with partial effacement of spinal fluid ventral to the spinal cord. There is encroachment of the right-sided exiting nerve roots at C4-5. This has progressed relative to the prior with a new encroachment of the right-sided exiting nerve roots.At C5-6 there is a diffuse disk bulge present associated with endplate reactive changes and effacement of spinal fluid ventral and posterior to the spinal cord. This was also present on the prior exam. There is bilateral neural frontal encroachment of the exiting nerve roots at this level. Since the prior exam endplate reactive changes at this level have converted to a chronic stage. Encroachment of the right-sided exiting nerve roots at this level appears to have worsened.At C6-7 there is a diffuse disk bulge present associated with some narrowing of the neural foramina bilaterally. This is stable since the prior examAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a T2 hyperintense lesion present within the right lobe of the thyroid measuring 7 mm in size. This was also present on the prior exam and does not appear to have changed substantially.
1.There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion and left thalamus lesion which are stable relative to the prior exam from 6/2/15.2.Since the previous examination the patient's spinal cord lesions compatible with demyelination are appear to have remained stable in number. A lesion in the spinal cord at C3 has regressed in size.3.Since the prior examination disc extrusion at C3-4 has regressed and now does not create spinal stenosis.4.Since the prior examination spinal stenosis at C5-6 associated with neural foramina encroachment has endplate reactive changes which are in the chronic phase but is otherwise relatively stable. The neural foramen encroachment at this level is worse on the right relative to the left side.5.Since the prior examination mild to moderate spinal stenosis at C6-7 due to disk protrusion and encroachment of exiting nerve roots remains stable.6.The right thyroid lobe lesion remains stable.