Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Eval for MS vs Transverse myelitis History: b/l LE numbness after travel to puerto rico Brain MRIThere scattered FLAIR/T2 high signal intensities at bilateral corpus callosum, bilateral frontal white matter (left more than right) and the left temporal periventricular white matter. The lesion is somewhat perpendicular toward the axis of corpus callosum suggesting possible demyelinating lesions such as multiple sclerosis.There is however patchy enhancement at the left hippocampus especially at the hippocampal head and amygdala with subtle increase in T2 signal intensity but no particular abnormal signal intensity seen on FLAIR. On gradient echo image, the lesion shows susceptibility artifacts indicating blood products within the lesion. There is no definitive mass formation on this scan, nor mass effects toward surrounding structures. Constellation of above findings suggest diagnostic possibility of capillary telangiectasia. Possibility of cavernous malformation may need to be excluded but low possibility. Other possibilities such as tumorous condition or gliotic changes are unlikely. The ventricles, sulci and cisterns are symmetric and unremarkable. 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.Whole spine MRIThere is focal T2/STIR high signal intensity lesion of spinal cord especially dorsal column area at the level of C5 which does not show any evidence of enhancement. There is another T2 high signal intensity lesion at the level of T5 with evidence of subtle enhancement but without evidence of local mass effects indicating possible active multiple sclerosis plaque.Other areas of spinal cord appear to be normal.The cervical spine shows subtle kyphotic angulation at the level of C34 with diffuse minimal bulging of disc at the level of C34 and C45.There is no evidence of spinal canal stenosis. No neuroforaminal stenosis at Cervical, Thoracic and Lumbar spines.
1. Multiple FLAIR/T2 high signal intensity lesions at bilateral white matter indicate possible diagnosis of multiple sclerosis.2. Multifocal (C5 and T5 level) spinal cord T2/STIR high signal intensity lesions suggesting spinal cord involvement of multiple sclerosis. The T5 lesion shows enhancement implying possible active lesion.3. Enhancing lesion with susceptibility artifacts at the left hippocampus head, indicating possible diagnosis of capillary telangiectasia.