Clinical question: MS, pres. Signs and symptoms: Headache. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a few punctate nonspecific foci of FLAIR and T2 hyperintensity in the subcortical white matter of cerebral hemisphere and minimally in the periventricular white matter. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.There are multiple tiny foci of susceptibility in bilateral cerebellar hemispheres and bilateral cerebral hemispheres which are suspicious for a small chronic microhemorrhages. The less likely possibility of cavernoma's cannot be entirely excluded.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI:Examination demonstrates normal signal intensity and anatomical alignment of cervical spine.There is no evidence of a spinal stenosis or neural foraminal compromise at any level.Examination at C3-C4 demonstrate a central and right paramedian small disc protrusion which effaces the ventral subarachnoid space and is in contact with the cord however without central spinal stenosis or cord signal abnormality.Additional tiny central disc protrusion at C2-C3 and C4-C5 levels are also present with only subtle bulge into the ventral subarachnoid space.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.Nonenhanced lumbar MRI:There is normal signal intensity and alignment of vertebral column.There is normal caliber, signal intensity and morphology of the lower thoracic cord from T10 inferiorly and no detectable abnormality of the cauda equina.No appreciable degenerative disease and no evidence of spinal canal or neural foraminal compromise or stenosis. Mild hypertrophic changes of posterior elements are however present.Images through perispinal soft tissues demonstrate bilateral small renal cysts which can be further evaluated with dedicated imaging. Unremarkable visualized SI joints.
1.Nonenhanced brain MRI demonstrate no acute intracranial findings. Few punctate flair hyperintensity in the periventricular and subcortical white matter which are nonspecific. Multiple tiny foci of cerebellar and bilateral cerebral susceptibility signal without FLAIR or T2 associated signal changes which could represent multiple small microhemorrhages.2.Nonenhanced MRI of cervical spine demonstrate normal signal intensity and caliber of the cervical and upper most visualized thoracic cord to T4 level. Central disc protrusion at C3-C4 with resultant partial effacement of ventral subarachnoid space, tiny central disc protrusion at C2-C3 and C4-C5 with minute bulge into subarachnoid space is noted. There is however no spinal canal or neural foraminal compromise/stenosis at any level.3.Unremarkable nonenhanced MRI of the lumbar spine. Please see above comments.