Patient with past medical history significant for neuromyelitis optica, myasthenia gravis associated with thymoma, and hypertension with lower extremity weakness. Evaluate for neuromyelitis optica lesions. Motion artifact somewhat degrades image quality.MRI Brain: There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which likely represent a combination of demyelinating lesions and/or underlying mild to moderate chronic small vessel ischemic changes. Some of these lesions are oval in configuration and oriented perpendicular to the lateral ventricles. Abnormal FLAIR hyperintensity is also seen along the undersurface of the corpus callosum. There is no pathological enhancement.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. A subtle punctate focus of susceptibility artifact in the right parietal white matter, which is less conspicuous compared to the prior study, may represent chronic hemosiderin deposition or calcification.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. An incidental left frontal scalp area of abnormal low signal is again seen, which may represent an exostosis or calcified hematoma. There is mucosal thickening within the bilateral maxillary sinuses.MRI Cervical spine: The cervical spine is in normal alignment, with exaggeration of the normal cervical lordosis. The vertebral body heights are well-maintained. There is minimal loss of disc height at C3-C4 and C4-C5 with disc desiccation throughout the cervical spine. There are scattered foci of T1 hyperintense signal within the cervical spine, which likely represent focal fatty replacement or fat-containing hemangiomas. The spinal cord is of normal caliber and signal. There is no definite pathological enhancement of the cord.At C4-C5 through C6-C7, there are mild disc osteophyte complexes/diffuse disc bulges with central prominence, mostnotably at C4-C5 where it abuts the ventral cord. There is mild ligamentum flavum thickening at C3-C4 and C4-C5. There is no significant central spinal canal or foraminal stenosis. There is an incidental right sided nerve root sleeve cyst at C7-T1. MRI Thoracic spine: There is exaggerated kyphosis of the thoracic spine. There is minimal chronic compression deformity of the superior endplate of the T2 and T5 vertebral bodies again noted. The partially imaged lumbar spine demonstrates abnormal signal and deformity at the superior endplate of the L2 vertebra, suspicious for new compression fracture. Deformity of the superior endplate of the partially imaged L3 vertebra is unchanged and may represent a Schmorl's node and/or chronic compression deformity. There is mild loss of disc space heights. There are scattered foci of T1 hyperintense signal within the thoracic spine, which likely represent focal fatty replacement or fat-containing hemangiomas. There is degenerative spondylosis of the thoracic spine with mild disc bulges throughout. There is no significant spinal canal stenosis. Redemonstrated is increased T2 signal intensity and decreased caliber of the thoracic cord most prominent from the T8-T9 disc level extending inferiorly to the upper T10 level. There is no definite pathological enhancement of thoracic cord.Incidental note is made of an enhancing T2 hyperintense lesion within the left lobe of the thyroid gland measuring at least 2.0 cm in craniocaudal dimension. A left upper lobe opacity is again noted. A right renal T2 hyperintense lesion measuring at least 6.0 cm is partially imaged as well as a 1.1 cm T2 hyperintense lesion, likely representing cysts.
1.Unchanged abnormal T2 signal in the supratentorial white matter, likely representing a combination of demyelinating lesions and chronic small vessel ischemic changes in a patient of this age. No evidence of enhancement to suggest active demyelinating lesion. 2.Mild spondylotic changes of the cervical and thoracic spine as detailed above, without significant spinal canal or foraminal stenosis. No MR evidence of demyelinating disease within the cervical cord.3.Unchanged mid to distal cord myelomalacia most prominent from the T8-T9 disc level to the upper T10 level which is non-specific at this time but may certainly represent sequela of prior myelitis.4.Mild chronic benign compression deformity of the superior endplates of T2, T5 and L3 again noted. 5.New compression fracture at the superior endplate of the L2 vertebra.6.Incidental left thyroid lesion, which is incompletely evaluated. Please correlate with thyroid ultrasound as clinically indicated.Incidental left upper lobe opacity, also seen in MR thoracic spine dated 8/15/2013. CT may be considered for further evaluation as clinically warranted.  