 Innumerable bilateral periventricular and subcortical white matter lesions are again demonstrated, without significant interval change. There are extensive lesions within the brainstem as well as the brachium pontis, best appreciated on axial PD images. Direct comparison is made to more remote study in 2010 where an axial T2 series is available, for better visualization of the brainstem lesions. Although some of the infratentorial lesions were present at that time, there is clear progression throughout the entire brainstem when compared to 08/14/10. Recent direct comparison is difficult given differences in technique. No definite new supratentorial lesions are identified when compared to the most recent prior.The ventricles and sulci are mildly prominent for age. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. There is a small amount of fluid in the left sphenoid sinus.
1.Redemonstration of innumerable white matter lesions, compatible with multiple sclerosis, including extensive infratentorial disease which has progressed since the remote 2010 exam. No definite new supratentorial lesions are identified.2.Overall, there is moderate T1 disease burden, and moderate T2 disease burden. 3.Mild diffuse volume loss, more than expected for age, likely relating to demyelinating disease.