Right leg weakness. Evaluate for new MS lesions. Brain: There are multiple, greater than 10, foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter with appearance and distribution of the lesions compatible with known demyelinating disease. Infratentorial lesions such as lesion involving the left middle cerebellar peduncle is also suspected as well as in the left lateral aspect of the pons at the nerve root entry zone of the left trigeminal nerve. Few lesions with T1 hypointensity are also noted. Brain parenchymal volume is preserved for age. No abnormal enhancing lesions within the brain are appreciated. No intracranial mass effect, extra-axial collections, or hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: There are multiple T2 hyperintense lesions in the cervical cord consistent with known demyelinating disease. The most prominent of these is seen involving the right lateral aspect of the cord and extends from the C2-C3 level to the C3-C4 level. Additional tiny lesions are seen at the left ventral base of C2 level and right ventral C2-C3 level on both the axial T2 and T2* mFFE sequences. No abnormal enhancement is definitively appreciated. Apparent areas of high signal on the axial post gadolinium sequence, which is motion degraded, such as at the right C2-C3 level, axial post gadolinium image 29, are favored to be artifactual. No abnormal enhancement on the sagittal sequence is appreciated.Vertebral body heights and alignment are maintained. Degenerative changes are seen including multilevel disc desiccation and small bulge at the C5-C6 level. There is no significant spinal canal stenosis at any level. There is uncovertebral hypertrophy and facet arthropathy with resulting moderate to severe right C3-C4 and right C4-C5 neural foraminal narrowing as well as milder changes at additional levels. There is a right thyroid nodule.
1. Multiple supra- and infratentorial lesions in the brain with distribution and morphology compatible with known demyelinating disease. No abnormal enhancement. 2. Multiple lesions within the cervical cord are also noted, most prominent at the right lateral aspect of the cord extending from the C2-C3 to the C3-C4 levels. No abnormal enhancement in the cervical cord is definitively appreciated within the limits of the motion degradation.3. An addendum can be made to this report if prior studies are made available for comparison.