Diagnosis: Multiple sclerosisClinical question: disease activity on GilenyaSigns and Symptoms: steroid side effects taper ending in one week MS--L sensory and weaknessComments: ? Interval change and activity on Gilenya | Do on Mon AM | There is redemonstration of a mild degree of periventricular and subcortical white matter lesions some of which are perpendicularly oriented to the lateral ventricles. Many of these are smaller on the current exam. There is also a right posterior medulla lesion which is bright on T2 and FLAIR MRI measuring about 8 mm in size which was also present on the prior exam but measured approximately 10 mm. There are small white matter lesions bright on FLAIR imaging located in the middle cerebellar peduncles which are smaller on the current exam. No abnormal enhancing lesions are appreciated in the brain parenchyma.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 demonstrate mucosal thickening in the right maxillary sinus there is a small air-fluid level present. The visualized portions of the mastoid air cells are clear. There is mild mucosal thickening in the ethmoid air cells. The visualized portions of the orbits are intact.
1.There is redemonstration of multiple white matter lesions as well as brainstem lesions which are stable in number compared to the previous exam. Please note that many of the lesions identified and appear smaller in volume. There is no convincing evidence for an acute lesion at this time.2.There is right maxillary sinus opacification with an air fluid level. This could represent retained secretions or acute sinusitis.