69-year-old male with a history of multiple sclerosis now with weakness, changes in speech and consciousness. Evaluate for an MS exacerbation. MRI Brain:Again seen are scattered hyperintense T2/FLAIR white matter abnormalities, which are grossly unchanged compared to the prior exam. There is a left parietal periventricular lesion suggestive of a chronic demyelinating lesion while most of the additional scattered foci demonstrate a more nonspecific appearance and may represent mild chronic small vessel ischemic changes. Apparent FLAIR hyperintense foci involving the middle cerebellar peduncles are likely artifactual.There is no evidence of intracranial hemorrhage, mass, or acute infarct. No evidence of intracranial mass effect, midline shift, or herniation. There is mild global parenchymal volume loss. There is a left lens implant. There is severe rightward nasal septal deviation. There is minimal paranasal sinus opacification. Bone marrow signal and remainder of the extracranial soft tissues are grossly unremarkable.MRI Cervical spine:There is no definite cervical cord signal abnormality with motion degradation slightly limiting evaluation.There is mild straightening of the cervical spinal curvature. The cervical vertebral bodies are appropriate in height. Bone marrow signal is benign. There are multilevel degenerative changes with disc height loss and disc osteophyte complexes throughout the cervical spine with up to moderate spinal canal stenosis at the C5-C6 level where there is mild impression on the left ventral aspect of the cord related to left paracentral disc osteophyte complex. There is also mild spinal canal stenosis at the C4-C5 and C6-C7 levels.There is prominent multilevel neural foraminal narrowing secondary to facet and uncovertebral hypertrophy throughout the spine with moderate to severe neural foraminal stenoses at the left greater than right C3-C4 level, bilaterally at C4-C5, bilaterally at C5-C6, right greater than left C6-C7, and to a milder degree at the left C7-T1 level. There is an ovoid posterior superficial subcutaneous lesion at the C4 level measuring 1.2 x 1.5 cm which may represent a sebaceous cyst and can be correlated with clinical exam.
1.No evidence of progression of demyelinating disease in the brain. No evidence of acute infarct or intracranial mass effect.2.No definite evidence of demyelinating disease in the cervical cord within the limits of mild motion degradation.3. Moderate degree of multilevel degenerative changes throughout the cervical spine with up to moderate spinal canal stenosis at the left C5-C6 level and moderate to severe neural foraminal stenoses at multiple levels as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.