Female, 63 years old, with multiple sclerosis and worsening spasticity. Brain:Numerous white matter T2 hyperintense lesions are seen involving the juxtacortical and periventricular white matter as well as the brainstem and minimally the cerebellum. Many of these lesions are oval in shape and oriented radially with respect to the ventricles. These lesions show varying degrees of associated T1 hypointensity ranging from minimal to marked. No definite associated enhancement is seen with these lesions, nor is there any pathologic enhancement elsewhere within the intracranial space.No significant parenchymal edema or mass effect is seen. The corpus callosum is perhaps mildly thinned which may reflect disease related volume loss. No intracranial hemorrhage or any abnormal extra-axial fluid is detected. Ventricular size and morphology are within normal limits.C-spine:Although image quality is somewhat degraded by motion artifact, a subtle but longitudinally extensive area of T2 signal abnormality is suspected within the spinal cord beginning at C2 and continuing down to C5 or C6. No significant cord swelling is seen in this area. There may be an additional more focal area of cord signal abnormality at T3. No pathologic cord or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow signal replacement or enhancement is detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal narrowing. Mild right and moderate left foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C5-6: Unremarkable. C6-7: Unremarkable. C7-T1: Unremarkable.
1.Numerous white matter lesions are demonstrated in the brain compatible with demyelinating disease and typical of MS in particular. These lesions demonstrate variable corresponding T1 hypointensity suggesting varying degrees chronicity. No definite enhancing lesions are seen.2.A subtle but longitudinally extensive region of signal abnormality is suspected within the spinal cord spanning from at least C2 down to C5. Such an appearance is relatively unusual for MS, though it could represent the accumulation of numerous, nearly confluent lesions in the context of long-standing disease. The possibility of an atypical demyelinating process can also be considered.