Male, 24 years old, multiple sclerosis. Recently diagnosed with MS, on October 2016 and has follow up with Dr Ciprianni at U of C. He was recently started on Tecfidera about 2 weeks ago. Over the last week he reports to be feeling progressive numbness on L hand and L toes. He was referred for admission for MS flare and treatment with IV steroids. Multiple imaging series are degraded by patient motion. Small T2/STIR hyperintense lesions are partially visualized on sagittal imaging in the right middle cerebellar peduncle and left cerebellar hemisphere white matter, which were better visualized on the outside brain MR examination. There are two small peripherally located foci of T2/STIR signal abnormality on the right at the C2 and C2-3 levels. The C2-3 level lesion may be new. A larger T2/STIR signal lesion in the spinal cord is present on the left from lower C4 level to the mid C6 level, which appears to be new. There is moderate associated expansion of the spinal cord at the C5 level. There is also enhancement of the lesion at the C4-C5 to the C5-C6 levels within the left and dorsal aspects of the spinal cord, suggesting active demyelination.There is normal alignment of the cervical spine, with normal cervical lordosis. Vertebral body and intervertebral disc heights are maintained. There is no significant disc bulge or herniation. No high-grade foraminal stenosis in the cervical spine, within the limitations of motion degradation. THORACIC SPINE
1. Interval progression of demyelinating disease in the cervical cord with a new lesion extending from the C4-C5 to C5-C6 levels involving the left and dorsal aspects of the cervical spinal cord. There is associated enhancement consistent with active demyelination.2. No abnormal signal identified in the thoracic spinal cord.3. Partially visualized demyelinating lesions within the left cerebellar hemisphere and right middle cerebellar peduncle, better visualized on outside MRI of the brain.