Multiple sclerosis with bilateral internuclear ophthalmoplegia, right dysmetria and right leg weakness. Evaluate for disease progression. Worsening back pain. MRI brain: Redemonstrated are moderate to extensive findings of demyelinating lesions in the periventricular and subcortical white matter of the bilateral cerebral hemispheres and corpus callosum. There is interval decrease in size of a few lesions in the left periventricular and parietal coronal radiata. There is new single left temporal occipital lesion. There is no evidence of pathologic intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is parenchymal volume loss. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRI thoracic spine: There is redemonstration of fairly extensive patchy T2 hyperintense foci of the spinal cord with associated decreased cord caliber. Lesions are most prominent at the left aspect of the T4-T5 level, right aspect of the T5-T6 level, left aspect of T9-T10 and right aspect of T10-T11. On post enhanced images there is no convincing evidence of an enhancing plaque. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.MRI of lumbar spine: The vertebral column is straightened but otherwise within normal limits in alignment. The vertebral body heights are preserved. There is loss of disc height with disc desiccation at L3-L4 and, L4-L5 and L5-S1. The distal spinal cord and conus also demonstrated patchy foci of T2 hyperintense signal with conus terminating at the L1-L2 level. There is a large left paracentral disc extrusion at L5-S1 with superior migration of 1.1 cm contributing to severe spinal canal stenosis with impingement of the descending nerve roots at this level left greater than right. Neural foramina and spinal canal at the remainder of the levels are patent. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. Incidentally noted is a leiomyomatous uterus.
1.Moderate to extensive amount of demyelinating lesions. There is a single new lesion involving the left temporal occipital junction. There is no evidence of enhancement to suggest active demyelinating process. Multiple previously seen enhancing lesions have evolved in the interval and no longer enhance.2.Extensive nonenhancing demyelinating plaques throughout the thoracic and upper lumbar spinal cord with resultant decreased cord caliber, not significantly changed compared to prior thoracic spine MR from 6/14/2014.3.Large disc extrusion at L5-S1 contributing to severe spinal canal stenosis at this level and impingement of the descending nerve roots.Leiomyomatous uterus is partially imaged which can be further assessed with ultrasound as clinically indicated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.