Diagnosis: Multiple sclerosisClinical question: MS; f/u progressionSigns and Symptoms: ataxia MRI brain:There is a moderate degree of periventricular and subcortical white matter lesions some which are perpendicularly oriented to the lateral ventricles and some of which extend to the corpus callosum. There are T2 and FLAIR punctate signal hyperintensity is also present in the internal capsules, external capsules as well as within the brainstem. These were also present on the prior exam from 1/6/2015 and have not changed tremendously.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are patchy small signal hyperintensities present throughout the cervical spinal cord which were also present on the prior exam as well. More prominent lesions are present at C2, C3-4, C4-5-7 which can also be identified on the prior exam. There is reversal of the normal cervical curvature present.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. There is a small central disc protrusion at this level.At C4-5 there is no significant compromise to the spinal canal. There is a small left paramedian disc protrusion at this level. There are bilateral uncovertebral osteophytes present this level which are associated with encroachment of exiting nerve roots. There is no significant change since prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small left paramedian broad-based disc protrusion at this level. There is no significant change since prior exam.At C6-7 there is no significant compromise to the spinal canal. There is a left lateral disc protrusion present this level which encroaches on the left-sided exiting nerve roots within the neural foramen. There is no significant change since prior exam.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.There are multiple lesions scattered throughout the periventricular and subcortical white matter as well as the brainstem and internal capsules which are compatible with patient's clinical diagnosis of multiple sclerosis and have not changed when compared to the previous exam.2.The multiple lesions within the cervical spinal cord which are compatible with patient's diagnosis of multiple sclerosis. These are stable since the prior exam.3.There are multilevel degenerative changes present cervical spine with reversal of the normal cervical curvature and neural foramen encroachment of exiting nerve roots at C4-5 and on the left side at C6-7