Diagnosis: Demyelinating disease of central nervous system, unspecifiedClinical question: assess for new MS lesionsSigns and Symptoms: acutely worsening spasticity in BL LEs Brain:Since prior exam patient has developed a new lesion in the right anterior aspect of the medulla which is high signal on T2 and FLAIR.The previously noted punctate lesion in the right centrum semiovale is not readily identified on the current exam. There is a new small T2 and FLAIR hyperintense lesion adjacent to trigone of the right lateral ventricle which was not readily appreciated on the prior exam. There is a punctate T2 and FLAIR hyperintense lesion in the left thalamus which was not readily appreciated on the prior exam. A left cerebral peduncle lesion is also more conspicuous on the current exam than on the prior. No abnormal enhancing lesions are appreciated within the brain parenchyma on the current exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. 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 demonstrate mucosal thickening along the left maxillary sinus there. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.MRI thoracic spine:There are T2 hyperintense lesions present in the thoracic spinal cord. One at the T2 vertebral body level was also identified on the prior cervical spine exam. One along the posterior aspect of the T1 vertebral body level in one at C7 were not readily appreciated on the prior cervical spine exam. Additional lesions are identified at T5 along the posterior aspect of the spinal cord associated with some mild atrophy of the spinal cord approximately 18 mm in length. Another one is identified at the T8 vertebral body level measuring approximately 15 mm in length on the superior-inferior dimension. Another one is present at the T11 vertebral body level and another one is present at the conus medullary is.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 are mild degenerative changes present in the thoracic spine with Schmorl's nodes in the lower thoracic spine.No abnormal enhancing lesions are appreciated in the thoracic spine.
1.Since prior exam patient developed new lesions in the right medulla as well as in the periventricular white matter. These are compatible with patient's diagnosis of demyelinating disorder and multiple sclerosis. Some other lesions are less conspicuous on the current exam. There is no contrast enhancing lesion to suggest subacute lesion. Overall there appears to be some progression of disease.2.Multiple lesions in the thoracic spinal cord are present some which could be identified on prior cervical spine exams and some of which appear to be new since prior cervical spine MRI. There are multiple lesions in the thoracic spinal cord to which there is no comparison thoracic spine MRI. These lesions are compatible with patient's diagnosis of demyelinating disorder and multiple sclerosis. Overall there appears to be some progression of disease.