Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: ParesthesiasComments: 3T, please ask Dr Saad Ali for the specifics of the MS protocol | MRI brain:There is redemonstration of multiple periventricular and subcortical white matter lesions which are hyperintense on FLAIR MRI imaging and hypointense on T1-weighted imaging. An additional lesion is present in the right thalamus which is high signal on FLAIR and T2 MR imaging and is unchanged since January 2015. Certainly since 2003 there is been significant progression of accumulation of more lesions. Since 2013 there has been some progression as well.A new lesion is present in the subcortical white matter of the right frontal lobe which is not as conspicuous on the prior exam on FLAIR MRI images 39 of 70 series 801.There is a FLAIR hyperintense lesion present in the medulla which was also present on the prior exam and is unchanged. Another one is present in the pons and is also unchanged.A lesion in the subcortical white matter of the right parietal lobe at the inferior parietal lobule and another at the right frontal periventricular white matter are a little smaller on the current exam when compared to the priorThe 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 cervical spine:There is a T2 hyperintense lesion extending from the medulla down to the upper cervical spinal cord at the C1 vertebral level. This was also present on prior exams.The cervical vertebral bodies are appropriate in overall alignment and height. \There is multilevel disc desiccation present.A small lesion is present in the right thyroid lobe measuring 4 mm in size which is hyperintense on T2 weighted imaging.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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.A couple lesions in the right hemisphere are somewhat smaller on the current exam whereas another one is a little bit larger indicating some mild waxing and waning of the patient's white matter lesions. This is consistent with a demyelinating process (Multiple sclerosis in this case). Overall the demyelinating process appears to have progressed over the years.2.No new lesions are identified in the cervical spinal cord. There is a lesion contiguous with the medulla lesion extending to the upper cervical spinal cord.3.There is a small right thyroid lobe lesion present which is nonspecific. Please note that MR is not accurate in evaluation of thyroid lesions. If clinically indicated ultrasound may be of benefit in evaluating this.