Reason: MS, new coordination issues on Tysabri, concern for MS flare History: fall, worsening coordination MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some of these are perpendicularly oriented relative to the lateral ventricles. There is regression of the size of the T2 and flair signal change in the several of these lesions, for example, several in the centrum semiovale bilaterally as well as one adjacent to the trigone of the right lateral ventricle. Associated contrast enhancement on the prior exam has also regressed.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 is patchy and discontinuous signal hyperintensity present within the cervical spinal cord from the C2 vertebral level to the C6 vertebral level without spinal cord enlargement. No abnormal enhancing lesions are identified in the cervical spine.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.There is a redemonstration of multiple lesions in the periventricular and subcortical white matter which are consistent with a diagnosis of demyelinating disorder. Compared to the prior exam some of the lesions appear smaller. Finding suggests that these lesions are now in a chronic stage.2.Multiple lesions are present throughout the cervical spinal cord which are suspicious for demyelination. Lack of contrast enhancement in the cervical spinal cord suggests that these are likely in the chronic stage