History of MS presenting with paresthesias. Evaluate for progression. Brain:Redemonstration of multiple foci of increased T2 signal in the cerebral white matter in a predominantly periventricular distribution compatible with the history of multiple sclerosis. There is also involvement of the corpus callosum. Overall findings are not significantly changed from prior. The larger lesions are associated with a stable decrease in T1 signal. No new lesions are identified. No evidence of acute ischemia, hemorrhage, or intracranial mass effect.  The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. Lumbar Spine:Vertebral body heights are preserved. Alignment is anatomic. There is loss of signal in the intervertebral disks at L3-4 compatible with disc desiccation. Increased T2 signal in the vertebral body endplates at L4-5 level which is new from prior and associated with increased signal within the intervertebral disc. No adjacent soft tissue inflammation or epidural collection. The distal cord is grossly normal in signal. The conus medullaris terminates at the mid L1 level.Level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L3-L4: Mild disc bulge eccentric to the right which effaces the right lateral recess and extends into the right neural foramen creating mild right neural foraminal stenosis. No central canal or left neural foraminal stenosis.L4-L5: Interval decrease in size of previously noted disc extrusion. There is still effacement of the left lateral recess, however this is significantly improved. Mild left neural foraminal narrowing. No significant central canal or right neural foraminal narrowingL5-S1: Mild disc bulge eccentric to the right partially effacing the right lateral recess and abutting the descending right S1 nerve root. No significant neural foraminal or central canal stenosis.
1. Stable findings of chronic demyelinating disease in the brain. No new lesions to suggest progression.2. Multilevel degenerative changes of the lumbar spine with interval improvement in previous seen disc extrusion at the left L4-L5 level and improvement in associated effacement of the lateral recess where there was mass effect on the left L5 nerve root. Please see details of additional levels as above.3. Interval increase in T2 signal within the L4-5 vertebral body endplates and intervertebral disc is likely on a progressive degenerative basis. Early discitis-osteomyelitis may appear similar however and can be considered in the appropriate clinical setting. 