Clinical question: Cord compression; lesion; tumor. Signs and symptoms: Bilateral lower extremity weakness, decreased anal sphincter. Pre- and post enhanced total spine MRI:Cervical MRI demonstrate extensive patchy foci of T2 hyperintensity throughout the cervical cord consistent with patient's known demyelinating disease. None of the lesions demonstrate enhancement. There is no convincing evidence of any definite interval change since prior exam in the extent of disease.Mild to moderate degenerative changes of cervical spine without evidence of spinal stenosis is again noted. There is no evidence of abnormal enhancement of the vertebral column.Thoracic MRI demonstrate multiple foci of T2 hyperintensity in the lower thoracic cord and conus consistent with patient's history of demyelinating disease. There is a demyelinating plaque at T11 level with resultant decreased cord caliber which also demonstrates subtle enhancement on post infused series (sagittal post enhancement series 4401 image 10). There are no prior MRI of thoracic spine for comparison. Mild degenerative changes of the thoracic spine is noted with normal anatomical alignment and without intravenous of central spinal stenosis or abnormal enhancement.Lumbosacral spine study demonstrate lesion within the conus of the cord without convincing evidence of enhancement. The signal intensity and overall morphology of cauda equina is within normal and without abnormal enhancement. Mild to moderate degenerative changes of lumbar spine without evidence of central spinal compromise or stenosis is noted. Incidental note is made of a mild chronic compression deformity of the superior endplate of L3. No compromise of neural foraminal is detected. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrates extensive primarily periventricular and corpus callosal findings of chronic demyelinating disease without abnormal enhancement. Similar signal changes in the left cerebral peduncle and pons are also noted and without abnormal enhancement. Precise comparison with prior exam is difficult due to significant technique difference between the 2 studies. Current exam is performed utilizing routine brain MRI with 5 mm slices compared to prior dedicated multiple sclerosis study with 2 mm slices. Within this limitation is no significant interval change to possible mild progression of demyelinating disease since prior exam.New since prior exam from 3-3-2015 however is extensive right hemispheric foci of hemorrhagic encephalomalacia. There is a resolving hematoma in the right inferior frontal lobe with extensive surrounding FLAIR and T2 hyperintensity and widening of the adjacent cortical sulci suggestive of atrophic changes. Large focus of FLAIR/T2 hyperintensity with chronic hemorrhagic changes is also noted in the right anterior, mid and posterior temporal lobe involving the cortex and subcortical white matter. There is resultant ex vacuo dilatation on the temporal horn and trigone of right lateral ventricle. There are regions of heavy cortical hemosiderin position in the right frontal and temporal lobes. The appearance of findings are more suggestive of posttraumatic changes and chronic hemorrhagic ischemic stroke is considered less likely however it cannot be excluded. There is no evidence of enhancement with the above described findings. If there are more recent exams (brain MRI or head CT) since March 2015 and are provided to the radiology department an addendum to this report will be submitted after comparison.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium demonstrate normal signal intensity and without abnormal enhancement.
1.Pre and post enhanced MRI of spine demonstrate diffuse chronic nonenhancing lesions of the cervical spine without change since prior study. Findings of demyelinating disease in the lower thoracic cord and conus with evidence of enhancement of a lower thoracic cord lesion which also demonstrate decreased cord caliber as detailed. There are no prior MRI of thoracic spine for comparison. There is no evidence of a spinal canal compromise or stenosis at any level. There is no detectable abnormal enhancement of the vertebral column.2.Pre and post enhanced brain MRI demonstrate extensive chronic nonenhancing findings of demyelinating disease which compared to prior study from March 2015 demonstrate no significant change to possible mild progression. New since prior exam however are extensive regions of hemorrhagic encephalomalacia extensively involving the right inferior frontal, right anterior, mid and posterior temporal lobes as detailed. Findings results in significant interval ex vacuo dilatation of the temporal horn and trigone of right lateral ventricle. Please review detailed repot above. If there are more recent exams (brain MRI or head CT) since March 2015 and are provided to the radiology department an addendum to this report will be submitted after comparison.