43 years Female (DOB:5/17/1973)Reason: please do dr Javed MS protocol and compare to prior History: left-sided weaknessPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a marked degree of periventricular white matter lesions and to a lesser degree subcortical white matter lesions in the periventricular white matter lesions many of which are perpendicularly oriented to the lateral ventricles and are bright on T2 and flair MRI. Since the September exam and there is enlargement of a subcortical white matter of the left parietal lobe which now measures 16 mm previously a lesion that measured 5 mm. There is also a new lesion adjacent to the left putamen of the basal ganglia measuring 13 x 10 mm axial dimensions.There is another new lesion present in the deep white matter of the left cerebellar hemisphere measuring 13 x 9 mm axial dimensions.Additional lesions bright on T2 and flair MRI are present in the left and right cerebellar hemispheres and the left pons which are stable. Corpus callosum lesions are redemonstrated as well. Although they are similar in distribution when compared the prior exam.Postcontrast imaging demonstrates small foci of enhancement in the right frontal lobe one in the periventricular white matter measuring 5 mm and another one in the right frontal subcortical white matter measuring 3 mm. Another punctate focus of enhancement is present in the left cerebral peduncle.There is redemonstration of small T1 hypointense, FLAIR isointense and proton density hyperintense lesion in the subcortical white matter of the right superior frontal gyrus measuring 5 mm in size which has been unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate some opacities in the right mastoid air cells which were also present on the prior exam and are unchanged. The visualized portions of the orbits are intact.
There are multiple periventricular and subcortical white matter lesions as well as corpus callosum, and cerebellum and pons lesions present with some waxing and waning of some of the lesions. These are compatible the patient's diagnosis of demyelination. Many of the lesions are new compared to the exam from September. There are couple enhancing lesions present in the right frontal lobe and another one in the left cerebral peduncle which are suspected to potentially represent more acute involvement