50 years Female (DOB: 6/20/1966)Reason: Worsening MS symptoms on Rituximab History: Severe disability, worsening swallow, neck flexion weaknessPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:There is redemonstration of a moderate degree of periventricular and subcortical white matter lesions. Many of these are perpendicularly oriented to the lateral ventricles. There is T2 and FLAIR signal hyperintensity present within the corpus callosum which was also present on the prior exam. When compared to the previous exam from July there is no compelling evidence suggesting progression or change when compared to the previous exam. Additional lesions in the brainstem are present which were also present on the prior exam and is also not significantly changed relative to the prior exam. These lesions are hypointense on T1-weighted imaging. There is no associated contrast enhancement with these lesions. Previously noted contrast enhancing lesion in the right parietal periventricular and subcortical white matter no longer enhance.Incidental note is made of a developmental venous anomaly in the right frontal lobe.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:The cervical vertebral bodies are appropriate in overall alignment and height. There are patchy T2 hyperintense lesions within the cervical spinal cord. There is no associated contrast enhancement with these lesions.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 loss of disc space height, desiccation and uncovertebral osteophytes associated with a disc bulge and some encroachment of the neural foramina bilaterally with encroachment of exiting nerve roots within the 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 extensive periventricular and subcortical white matter lesions as well as lesions in the brainstem compatible with patient's diagnosis of demyelinating disorder. There is no significant interval change when compared with previous exam from July.2.There are multiple patchy lesions identified in the cervical spinal cord which are unchanged compared to the prior exam.3.There are degenerative changes present in the cervical spine worse at C5-6 where there is encroachment of exiting nerve roots within the neural foramina