37 years, Male, multiple sclerosis. Ataxia. Brain: There is moderate degree of confluent T2/FLAIR hyperintensity in the periventricular and subcortical white matter which is nonspecific but compatible with extensive demyelinating disease. There is also moderate degree of global parenchymal volume loss with diffuse thinning of the corpus callosum. There is also a moderate burden of T1 hypointense lesions in the supratentorial brain. Several infratentorial lesions are also evident including the right middle cerebellar peduncle and bilateral cerebellar hemispheres. Small midbrain and pontine lesions are also suspected. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus.Cervical spine: There is motion degradation on multiple cervical spine sequences significantly limiting evaluation of demyelinating disease. There is however suggestion of small patchy areas of T2 signal abnormality throughout the cervical cord. Cervical cord volume is grossly preserved. There is no significant spinal canal stenosis or neural foraminal stenosis at any level. Vertebral body heights are maintained. Alignment is maintained aside from straightening which may be in positional. Bone marrow signal is benign.There is an ovoid subcutaneous lesion in the left lower neck posteriorly measuring approximately 3 cm in the transverse dimension and 12 mm in the AP dimension with T1 and T2 hyperintensity and suggestion of chemical shift artifact, findings which favor a lipoma. There is apparent high signal on the STIR sequence which appears to be along the lateral margin of the lesion.
1. Extensive white matter signal abnormality involving the supra and infratentorial brain which is compatible with advanced demyelinating disease. There is also a moderate degree of global parenchymal volume loss and burden of T1 hypointense lesions. Addendum can be issued if comparison study is made available.2. Cervical spine sequences are significantly motion degraded although there is suggestion of multiple small lesions throughout the cervical cord compatible with demyelinating disease.3. Benign-appearing lesion in the subcutaneous tissues of the left lower neck posteriorly, favored to represent a lipoma with proteinaceous cyst an alternative possibility. Lipoma can be confirmed with an axial T1 fat-sat sequence through this lesion if clinically warranted. 