Clinical question: Rule out enhancing lesion or new lesion compared to prior study. Signs and symptoms: Spastic parapresis Pre-and post-enhanced brain MRI:Near diffusion weighted series. Examination redemonstrate multiple small foci of hyperintensity (demyelinating plaques) in the periventricular and subcortical white matter of bilateral cerebral hemispheres, small lesion in the right anterior pons and left middle cerebellar peduncle which appear similar in size and number to prior exam. There is no convincing evidence of any new demyelinating plaque. There is no detectable abnormal enhancement of any of the lesions and post-enhanced images are essentially negative.Cortical sulci, ventricular system and CSF spaces are within normal patient stated each and stable since prior exam.Unremarkable images through the orbits and including axial fat sat post enhanced series.Pre-and post enhanced cervical MRI:Examination demonstrated multiple small foci of T2 hyperintensity throughout the cervical the spinal cord. There is questionable subtle further increased T2 signal intensity of the cervical cord at C2 adjacent to previously seen lesions at this level. This finding however can be entirely technique related and there is no detectable abnormal enhancement. This finding is only suspected on sagittal T2 stir series 1701 on image 7 and cannot be confirmed with certainty on any other MRI sequence. There is no detectable abnormal enhancement of the cord or the leptomeninges on post enhanced series.Degenerative changes of the cervical spine are again noted without significant change since prior exam. Prominent disk protrusion and C4 -- C5 demonstrate interval decreased size and better visualization of the ventral subarachnoid space. Disk osteophyte complex at C3 -- C4 with subtle mass-effect and posterior displacement of the cord also demonstrate no appreciable interval change.No significant central spinal stenosis at any level.The uppermost visualized thoracic cord and thoracic spine to T4 level is unremarkable
1.Mild findings of chronic multiple sclerosis both in the supra-and infratentorial brain parenchyma and without convincing evidence of interval change since prior study or any enhancing plaques.2.Extensive findings of multiple sclerosis of the cervical cord without convincing evidence of interval change and without detectable abnormal enhancement. Please see above comments.