Reason: Eval for demyelinating disease History: paresthesias MRI brain:There is redemonstration of punctate signal hyperintensities located in the pons which are stable compared to the prior exam.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. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is right-sided facet hypertrophy present. This is unchanged compared to the prior examAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disk materialAt C4-5 there are endplate and uncovertebral osteophytes present associated with a diffuse disk bulge and posterior ligamentous hypertrophy. There is associated effacement of spinal fluid ventral and posterior to the spinal cord. There are bilateral uncovertebral osteophytes present at this level associated disk material and narrowing the neural foramina bilaterally. Compared to the prior exam these findings at the this level have progressed. There are endplate reactive change is present at this level which may be subacute with some bright signal on T2 and dark signal on T1.At C5-6 there is loss of disk space height and disk desiccation, endplate and uncovertebral osteophytes with effacement of spinal fluid ventral and posterior to the left hemicord and encroachment of the exiting nerve roots left more than right. Overall this appears relatively stable compared to the prior exam.At C6-7 there is a loss of disk space height, disk desiccation and diffuse disk bulge associated with endplate and uncovertebral osteophytes and partial effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the left-sided exiting nerve roots within the neural foramen.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.Pontine lesions are stable when compared to the prior exam in general the are suggestive of vascular related lesions, however, they are nonspecific and could relate to other cause such as vasculitis or demyelination.2.Since the prior exam degenerative changes at the C4-5 have progressed and now there is a moderate degree of spinal stenosis present at this level associated encroachment of the exiting nerve roots bilaterally.3.Since the prior exam degenerative changes at C5-6 and C6-7, where there is encroachment of left-sided exiting nerve roots and encroachment of the left hemicord at C5-6 and a mild to moderate degree of spinal stenosis C5-6, have remained relatively stable.