Multiple sclerosis [G35], Reason for Study: ^Reason: new lesions History: MS/ worsening weakness legs Brain MRIThere are multiple multiple new FLAIR high signal intensity lesions on the right periventricular white matter indicating interval aggravation of the demyelinating lesions.Previously seen multifocal bihemispheric periventricular white matter lesions were seen and unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.L-Spine MRI:For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multifocal patchy high signal intensity lesions on the spinal cord especially at the level of T10, 11, 12 and L1 suggesting possible demyelinating lesions. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1 level.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: central to left disc protrusion results left lateral recess stenosis abutting left S1 nerve root.
1. Interval increase in number of the right periventricular white matter demyelinating lesions as described above.2. Evidence of spinal cord demyelinating lesions suggesting spinal cord involvement.3. Disc herniation at the level of L5S1 with left lateral recess stenosis. 