 There are multiple scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter with a nonspecific distribution. There is also abnormal signal within the bilateral pons. No lesions with enhancement are appreciated. There is a small left parietal developmental venous anomaly which is incidentally noted.No intracranial mass or mass effect. Brain parenchymal volume is preserved. No hydrocephalus. No extra-axial collections. There is diffuse opacification involving the right maxillary sinus which is small, which may reflect atelectasis from chronic sinusitis.CERVICAL SPINE
1. Multiple nonspecific scattered foci of T2/FLAIR hyperintensity in the brain which may be related to small vessel ischemic disease and/or prior inflammation or perhaps demyelination. Overall distribution of the lesions however is not typical for demyelinating disease. No enhancing lesions in the brain.2. Abnormal enhancement involving the dorsal medial aspect of the cord from the C4 level down to at least the mid thoracic level which overall appears similar to prior study from 3/26/2016. Differentials remains broad include an ongoing inflammatory process such as sarcoid, long segment demyelination such as with NMO, or perhaps toxic metabolic injury effecting the dorsal columns such as subacute combined degeneration or vacuolar myelopathy. Despite the persistent enhancement, which is in usual, there is no discrete mass evident and neoplasm seems less likely.3. Note patient could not tolerate the entire study and post gadolinium images of the lumbar spine or axial post gadolinium images of the lower thoracic spine were not obtained.