60 year-old male with worsening lower extremity numbness, date disturbance, multiple sclerosis Brain: Given differences in technique, there has been no significant change in the patients burden of T2 hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. A previously demonstrated prominent left frontal lobe lesion has decreased in size. There are also multiple infratentorial lesions in the brainstem and cerebellar hemispheres. Lesions are also noted in the dorsomedial midbrain and upper pons including the region of the medial longitudinal fasciculus, particularly on the left which may explain patient's internuclear ophthalmoplegia. Minimal enhancement is noted within a right periatrial/periventricular lesion (series 24, image 12). There is also mild parenchymal volume loss with mild thinning of the corpus callosum for age. There is no intracranial mass, mass effect, midline shift or herniation. No hydrocephalus.Cervical Spine: Redemonstrated are T2 hyperintense lesions within the cervical cord with morphology and distribution consistent with known demyelinating disease, stable in appearance. As before, the most prominent lesions are present at the C2 level involving the bilateral posterior aspects of the cord, right greater than left, as well as at the left ventrolateral C3-C4 level. None demonstrate contrast enhancement. Mild volume loss is redemonstrated involving the dorsal cervical cord associated with the C2 lesions.Vertebral body heights and alignment in the cervical spine are normal. Minimal degenerative changes include small disc osteophyte complex, eccentric to the right at the C4-C5 level. There is no significant spinal canal stenosis at any level. There is mild to moderate multilevel neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy, relatively worse at the right C4-C5 level, unchanged.
1.Given differences in technique, there has been no significant change in the patients burden of T2 hyperintense lesions in both supratentorial and supratentorial brain. A previously demonstrated prominent left frontal lobe lesion has decreased in size. Minimal enhancement is noted within a right periatrial/periventricular lesion (series 24, image 12).2.Redemonstrated are T2 hyperintense lesions within the cervical cord, stable in appearance, without enhancement.3.Both brain and cervical cord findings are consistent with the provided history of multiple sclerosis.