Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: cognitive declineComments: 3T DCAM, Dr Javed MS protocol version 1.1, No DTI | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of periventricular and subcortical white matter T2 and FLAIR signal hyperintense lesions in both hemispheres of the brain. When compared to the 9/20/2013 exam there does not appear to be convincing evidence for progression of these lesions. Additional lesions are present in the internal capsules, pons, medulla, cerebral peduncles and middle cerebellar peduncles which were also present on the prior exam as well and are unchanged. These lesions are also associated with T1 hypointensity.Normal 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 right transverse and sigmoid sinuses are larger than the left upper parts.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.
Periventricular, internal capsule and subcortical white matter lesions and posterior fossa white matter lesions are present which are compatible with patient's diagnosis of demyelinating disorder. These are unchanged since the 2013 exam.