Clinical question: Progressive bilateral lower extremity weakness and paresthesias of her feet, hands and tongue. Rule out multiple sclerosis. Signs and symptoms: As above. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate periventricular, subcortical, corpus callosum, midbrain, bilateral middle cerebellar peduncles and medullary foci of FLAIR hyperintensity without associated mass effect or hemorrhagic changes and without detectable abnormal enhancement. The morphology, distribution and signal intensity of the findings are highly suggestive of chronic demyelinating disease of moderate degree. Postcontrast images demonstrate a tiny left inferior frontal developmental venous anomaly of no clinical significance.There is mild prominence of cortical sulci mostly in the parietal region for patient of stated age. The ventricles remain within normal size and with maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits and paranasal sinuses.Pre- and post enhanced cervical MRI:Examination demonstrates diffuse patchy foci of T2/T2 STIR hyperintensity throughout the cervical spine and medulla without abnormal enhancement or change in the cord caliber. Findings are consistent with chronic demyelinating disease of moderate to advanced degree. Mild degenerative changes throughout the cervical spine is noted however without significant central spinal stenosis at any level.Pre and post enhanced thoracic MRI:This examination also demonstrate mild diffuse findings of demyelinating disease throughout the thoracic cord which is best appreciated on axial T2 series. There is short segmental decreased cord caliber in the lower thoracic cord secondary to demyelinating disease.There is no detectable abnormal enhancement of the cord or the leptomeninges.Mild to moderate degenerative changes of the discs and hypertrophic changes of the ligamentum flavum posteriorly are noted. There is however no evidence of central spinal stenosis at any level.
1.Pre and postcontrast enhanced brain MRI demonstrates findings consistent with moderate chronic demyelinating disease as detailed.2.Pre and post contrast cervical MRI demonstrate diffuse findings of chronic migraine headache and disease without significant change in cord caliber.3.Pre- and post enhanced thoracic MRI demonstrates findings of demyelinating disease of the thoracic cord without detectable abnormal enhancement. There is a focal segmental decreased cord caliber in the lower thoracic cord and unremarkable thoracic cord caliber otherwise.