Clinical question: MS flare. Signs and symptoms: Gait instability, slow speech. Pre-and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a single new focus of flair hyperintensity in the posterior upper medulla with evidence of subtle increased parenchymal volume and enhancement. Findings consistent with a new active enhancing demyelinating plaque. This finding measures approximately at 7 x 11 x 10-mm on flare images.The previously noted a large enhancing plaque in the upper pons and with extension into the right cerebral peduncle demonstrates interval decrease in size and with resultant decreased caliber of pons and right cerebral peduncle. This lesion however demonstrate patchy foci of enhancement although less conspicuous and smaller in size compared to prior exam.Few additional foci of flare hyperintensities consistent with chronic demyelinating plaques in bilateral cerebral hemispheres demonstrate no change.
1.There is a single new enhancing plaque in the dorsal aspect of medulla as detailed/measured above.2.Interval decreased size and extent of the enhancement of a large plaque in the pons since prior exam.3.Stable mild additional chronic findings of demyelinating disease since prior study.