Clinical question: MS, previously on chemotherapy, TY sabri, now Rituxan, severe fatigue. Signs and symptoms: Severe crushing fatigue. Slow processing, on Rituxan. Nonenhanced brain MRI:There is no acute intracranial process and diffusion-weighted images are negative.Compared to prior exam there is evidence of interval decreased size of several of the demyelinating plaques since prior exam. There is a left periventricular white matter plaque that appears minimally larger than prior exam however this could be as result of slice positioning. Ventricular system remains mildly prominent supratentorially and stable since prior exam maintained midline. There is a focus of FLAIR hyperintensity in the posterior aspect of the left cerebral peduncle (axial FLAIR series 801 image 14) which cannot be identified with certainty on prior study. Prior exam however demonstrated demyelinating lesions in the midbrain.Images through posterior fossa demonstrate a lesion in the immediate right paramedian anterior medulla measuring at 6 x 6 mm in transaxial dimensions (axial FLAIR series 801 image 8). This finding was present on prior study on axial flair series 701 image 7 on brain MRI 2-25-15 however appears more conspicuous which is could be due to slice positioning.Unremarkable images through the orbits, calvarium and paranasal sinuses.
1.No acute intracranial process.2.Revisualization of changes consistent with patient's known demyelinating disease. Interval decreased size of several of the demyelinating plaques since prior exam. No convincing evidence of new lesions however please review detailed report above.