Diagnosis: Multiple sclerosisClinical question: hx of MS, new right arm paresthesias, electric shock sensationSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular white matter lesions present which are perpendicularly oriented to the lateral ventricles as well as some corpus callosum lesions especially at the colossal cingulate junction and to some degree some subcortical white matter lesions. These are hyperintense on FLAIR and T2 imaging. There is no associated contrast enhancement. Additionally there are punctate lesions present in the cerebellar hemispheres bilaterally. These also do not enhance following gadolinium administration and they are hyperintense on FLAIR and T2 images. These lesions have not changed since the prior exam of 2/14/2014Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is a patchy T2 and FLAIR hyperintense lesion present along the posterior aspect of the cervical spinal cord extending from the C1-2 level down to the C7 vertebral level which has not changed substantially when compared to the prior exam. There is no associated enhancement of this lesion following gadolinium administration. There is no associated mass effect.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There are periventricular and subcortical white matter lesions present as well as lesions in the corpus callosum and cerebellum which are compatible patient's diagnosis of demyelinating disorder. These are stable compared to the prior exam.2.There is redemonstration and no significant change of extensive lesion within the cervical spinal cord. This is compatible with the patient's clinical diagnosis of demyelinating disorder. It is stable compared to the prior exam.