Diagnosis: Multiple sclerosisClinical question: please do Dr Javed MS protocol, c/w priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. No abnormal enhancing lesions are identified in the cervical spine. There is a small T2 hyperintense lesion present along the right posterior lateral aspect of the spinal cord at the C3-4 disc space level. There is a small T2 hyperintense lesion along the left posterior lateral aspect of the spinal cord at the C6-7 level. There is a T2 hyperintense lesion measuring 11 mm in superior-inferior length along the posterior aspect of the spinal cord at the T1 vertebral level.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. There is a mild disc bulge present at this level.At C5-6 there is a disc bulge present associated with hypertrophy of the ligamentum flavum and partial effacement of spinal fluid ventral and posterior to the spinal cord. There is some narrowing of the left neural foramen at this level as a result of disc material with encroachment of left-sided exiting nerve roots. Overall there is a mild to moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is a T2 hyperintense lesion measuring 11 mm in superior-inferior length along the posterior aspect of the spinal cord at the T1 vertebral level. This is associated with mild mass effect but no contrast enhancement.There is a T2 hyperintense lesion along the right posterior lateral aspect of the spinal cord at the T6-7 disc space level.A small disc protrusions present along the right paramedian region at the T7-8 level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.
1.There are multiple lesions identified in the cervical and thoracic spinal cord which are suspicious for demyelinating lesions. The largest one is at the T1 vertebral level. Lack of contrast enhancement suggests that these are not acute.2.On the available pulse sequences, there are no lesions identified in the brain parenchyma to suggest demyelination.3.There are some degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C5-6 and some encroachment of the left-sided exiting nerve roots at C5-6.