Diagnosis: Anesthesia of skinClinical question: evaluate for demyelinating or other lesionSigns and Symptoms: ascending numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate T2 and FLAIR signal hyperintense lesion present in the left superior frontal gyrus. There are no foci of diffusion restriction appreciated. Additionally there are a couple periventricular white matter lesions which are hyperintense on T2 and FLAIR imaging.No abnormal mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 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 orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a focus of T2 signal hyperintensity centered in the spinal cord at the C2 vertebral body level centered along the posterior aspect and right paramedian aspect of the spinal cord. This associated with mild cord enlargement.There is a T2 hyperintense lesion along the periphery of the the left hemicord at the C6 vertebral body level. This is not associated with cord enlargement.There is a punctate T2 hyperintense lesion present along the cervical spinal cord at the C3-4 disc space level at the right posterior lateral aspect of the spinal cord which is rather subtle.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 no significant compromise to the spinal canal or 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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a subtle focus of T2 hyperintensity within the spinal cord at the T12 vertebral body level. This is best seen on the lumbar spine MRI.The assessment of the thoracic spinal cord on T2-weighted imaging is somewhat degraded due to phase encoding artifacts.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is disc desiccation present at L3-4 and L4-5. There is a subtle focus of T2 hyperintensity within the spinal cord at the T12 vertebral body level. This is best seen on the lumbar spine MRI.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a mild disc bulge at this level. A small focus of T2 hyperintensity is present along the posterior aspect of the annulus of the L4-5 disc. There is mild loss of disc space height at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a mild disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.The patient was unable to complete the exam. No post gadolinium imaging was performed.2.There are multiple lesions present in the cervical spinal cord as well as in the distal thoracic spinal cord which are suspicious but not specific for demyelination. Please note that the thoracic spinal cord is a somewhat degraded by phase and coding artifact. Perhaps repetition of the T2-weighted imaging of the thoracic spine with a saturation bands would be helpful in reducing the artifact when and if the patient comes back for post gadolinium imaging.3.Although no orbital lesion is identified postcontrast imaging may be helpful in identifying optic neuritis if present.4.There are several subcortical and periventricular white matter lesions identified which are too few to create a pattern since this is not an uncommon finding. It is possible that these are related to demyelination, however, they are nonspecific.