History of demyelinating lesions in the cervical spine. Evaluate for optic nerve lesions as there is clinical concern for an NMO versus MS. Reevaluated spine lesions. Orbits: The globes are intact. There is questionable increased STIR signal and subtle thickening of the immediate postchiasmatic left optic nerve (series 501 images 22-23) with very equivocal enhancement. This could in part potentially represent volume averaging with adjacent CSF. No orbital mass. Extraocular muscles are normal in signal and morphology. The visualized intracranial contents are unremarkable and without evidence of acute ischemia, mass, mass effect, or edema. Visualized paranasal sinuses demonstrate minimal mucosal thickening in the right maxillary sinus. The visualized mastoid air cells are clear. Cervical spine:Again seen is a focus of abnormal increased T2 signal in the midline dorsal cord at the C5-6 level. This is slightly decreased in size measuring 4 x 2 mm (previously 5 x 4 mm) and there has been progressive volume loss in the cord at this level. More subtle increased signal in the dorsal cord at the C2 level is decreased compared to prior. No new lesions. No abnormal enhancement is noted on the postcontrast images. There is straightening of the cervical lordosis. The vertebral body heights are preserved. Multilevel degenerative disc disease with loss of intervertebral disc height and intervertebral signal most notably from C3 to C7. Reactive marrow endplate changes are present at C6-7. Interval development of focal enhancement and minimal edema in the paraspinal musculature adjacent to the C6 spinous process may represent a muscle strain.Level by level findings are as follows: C2-C3: Minimal disc bulge eccentric to the left. No significant neural foraminal or spinal canal stenosis.C3-C4: Moderate disc osteophyte complex asymmetric to the left. Minimal left neural foraminal stenosis. No spinal canal or right neural foraminal narrowing.C4-C5: Prominent disc osteophyte complex with a superimposed central disc protrusion which effaces the ventral thecal sac and creates moderate spinal canal stenosis. No significant neural foraminal stenosis.C5-C6: Moderate disc osteophyte complex asymmetric to the left which in combination with uncovertebral joint hypertrophy creates severe left neural foraminal stenosis. Mild to moderate spinal canal stenosis. Minimal right neural foraminal stenosis.C6-C7: Moderate disc osteophyte complex and uncovertebral joint hypertrophy. Moderate to severe spinal canal stenosis with effacement of the ventral and dorsal thecal sac. Severe left and moderate to severe right neural foraminal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Thoracic spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. Round foci of increased T1 and T2 signal which suppresses on the STIR sequence in the T11 and T12 vertebral bodies compatible with intraosseous hemangiomas. Marrow signal is otherwise within normal limits. No significant neural foraminal or spinal canal stenosis.The visualized cord is normal in signal and morphology. No evidence of demyelinating disease. No abnormal enhancement on the postcontrast images.
1. Questionable thickening and increased STIR signal in the immediate postchiasmatic left optic nerve as described. This may reflect demyelinating process if clinically appropriate, or in part may relate to artifact/volume averaging.2. Redemonstrated demyelinating lesions within the cervical spine. The primary lesion at C5-C6 is slightly decreased in size and associated with progressive loss of cord volume consistent with expected evolution of a now chronic demyelinating lesion. The more ill-defined abnormal signal in the proximal cervical cord is decreased compared to prior. No associated enhancement or new lesions.3. Multilevel degenerative changes within the cervical spine which create moderate to severe spinal canal stenosis at C6-C7. Multilevel neuroforaminal compromise which is most severe on the left C5-6 and C6-7 levels.4. No evidence of demyelinating lesions in the thoracic spinal cord.