Reason: new or active MS lesions? History: Worsened L-sided spasticity MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These appear to be stable. There is subtle gyral signal hyperintensity in the left middle frontal gyrus present identified on FLAIR MRI image #27.There is redemonstration of foci of signal hyperintensity centered in the globus pallidi(5mm on the left and 3mm on the right) - image #15 of coronal T2, image #16 on axial T2 and image #17 on FLAIR with signal loss on T1 - image #17. There is no associated contrast enhancement. It is stable since 2011.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A cystic lesion in the high occipital scalp tissues at the junction with parietal scalp along the midline is likely a pilonidal cyst.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 are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disk dessication present.There is abnormal signal and loss of volume along the left posterolateral aspect of the spinal cord from the T2-3 to the T3-4 disk space levels. There is no associated contrast enhancement in the cervical spinal cord.No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small centra disk protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level with associated endplate osteophytes.At C5-6 there is loss of disk space height, disk dessication and a disk bulge at this level associated with posterior ligamentous hypertrophy, bilateral uncovertebral osteophytes and endplate osteophytes. There is effacement of spinal fluid ventral and posterior to the cord. There is encroachment of the exiting nerve roots at this level.At C6-7 there is no significant compromise to the spinal canal . There is a left lateral disk protrusion at this level encroaching on the left exiting nerve roots at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The LVA is larger than the RVA.
1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are stable. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.The globus pallidus lesions are present but stable since the prior exam. Because the globus pallidi are vulnerable to metabolic abnormalities and many systemic or generalized disease processes and underlying metabolic or toxic (carbon monoxide fore example) process may be considered. Please correlate with the patient's clinical history.3.There is a spinal cord lesion present extending from the C2-3 disk level to the C3-4 disk level. This is compatible with demyelination.4.There are degenerative changes present in the cervical spine with moderate spinal stenosis at C5-6 and encroachment of the exiting nerve roots bilaterally at C5-6 and on the left side at C6-7.5.There is no evidence for optic neuritis identified based on this exam and no evidence for active MS in the brain, optic nerves or cervical spinal cord based on the lack of contrast enhancement.