Paresthesias, evaluate for progression of demyelinating disease. Brain: Again seen are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter not appreciably changed compared to 6/12/2015. No new lesions. There is subtle focus of enhancement in the right posterior frontal lobe, series 4 image 12 with enhancement not present on the 3-D SPGR sequences likely related to differences in technique and contrast timing. There is corresponding T2 FLAIR hyperintensity which was present on prior study from 6/12/2015 but did not demonstrate enhancement. As such this may represent new enhancement within pre-existing lesion versus chronic enhancement which was not appreciable previously due to technique. Subtle focus of enhancement is also suspected in the right ventral pons, series 3 image 130 also not appreciated on prior.Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Evidence of prior left parietal burr hole placement for biopsy with gliosis involving the adjacent cortex again seen. Visualized extracranial soft tissues are unremarkable.Cervical spine: There is minimal patchy T2 signal abnormality throughout the cervical cord without findings to suggest a new discrete lesion. No discrete/large lesion with enhancement is appreciated. There are subtle foci of enhancement which are again questioned in the cervical cord, such as at the C1 level sagittal series 9 image 8 and at the left C4 level, sagittal series 9 image 9. Previously described foci of enhancement at the C2 level and right lateral C6 level are no longer appreciated.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.
Compared to 6/12/2015, there are small scattered T2/FLAIR hyperintense lesions in the white matter which are not appreciably changed since 6/12/2015. There are tiny foci of enhancement, such as in the right posterior frontal lobe and right ventral pons which were not appreciated on prior. Similarly in the cervical cord, there are tiny T2 hyperintense lesions which overall are not appreciably changed. There are subtle foci of enhancement in the cervical cord which appear new, while subtle enhancing foci present on prior study which are no longer appreciated on the current study. Overall, these tiny areas of enhancement in the brain and cervical cord suggest ongoing inflammation/demyelination. Given their small size (1-3 mm) it is possible that they represent chronic subtle enhancing foci with apparent fluctuation possibly related to differences in technique/contrast timing. 