Multiple sclerosis, lower extremity weakness. Again seen are greater than 20 T2/FLAIR hyperintense lesions in the supratentorial white matter as well as infratentorially including the left middle cerebellar peduncle and cerebellar hemispheres. Compared to 9/18/2012, there is evidence of interval progression with at least 3 new lesions which are identified including the right frontal lobe, right inferior parietal lobule, as well as the left post central gyrus. No lesions with enhancement are definitively appreciated to suggest active demyelination. There is questionable peripheral enhancement on coronal post gad sequence series 12 image 10 but not present on the axial post gadolinium spin echo or 3D post gadolinium SPGR sequences and favored to be artifactual. Few lesions with T1 hypointensity are also seen. There is mild volume loss including the corpus callosum. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Greater than 20 supratentorial and infratentorial white matter lesions consistent with known demyelinating disease. There is evidence of progression compared to 9/18/2012 with at least 3 new lesions identified. No lesions without enhancement are definitively identified to indicate active demyelination. Please see comment above.2. Mild parenchymal volume loss including the corpus callosum.