Diagnosis: Disturbance of skin sensationClinical question: please do Dr Javed MS protocol on 3 Tesla MRI, compare to image in PAXSigns and Symptoms: numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a punctate T2 and T2 and FLAIR hyperintense lesion present in the right temporal lobe subcortical white matter which is unchanged since the prior exam. Additionally there are several more subcortical white matter lesions in the subcortical white matter of the frontal lobes which also present on the prior exam and are unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present with mild reversal centered at C5-6. Mild disc bulge present at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There are several subcortical white matter lesions present in the brain which are nonspecific and most likely of little clinical relevance given their number and stability.2.No cervical spinal cord lesions are appreciated to explain the patient's symptoms.3.There is a minor disc bulge present at C5-6 without significant compromise to spinal canal or exiting nerve roots