Anesthesia of skinClinical question: demyelinating disease?Signs and Symptoms: numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of enhancement along the left superior parietal lobule next to the intra-parietal sulcus.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a focus of T2 signal hyperintensity centered in the spinal cord at the C2 vertebral body level centered along the posterior aspect and right paramedian aspect of the spinal cord. This associated with mild cord enlargement and contrast enhancement.There is a T2 hyperintense lesion along the periphery of the the left hemicord at the C6 vertebral body level. This is not associated with cord enlargement or contrast enhancement.There is a punctate T2 hyperintense lesion present along the cervical spinal cord at the C3-4 disc space level at the right posterior lateral aspect of the spinal cord which is rather subtle. This is not associated with cord enlargement or contrast enhancement.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.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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a subtle focus of T2 hyperintensity within the spinal cord at the T12 vertebral body level. There is no associated contrast enhancement.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.
1.There are multiple lesions present in the cervical spinal cord as well as in the distal thoracic spinal cord which are suspicious but not specific for demyelination. Post contrast imaging indicates that a lesion in the upper cervical spine at the C2 level is in the subacute/acute phase.2.There is no evidence for optic neuritis.3.There are several subcortical and periventricular white matter lesions identified which are too few to create a pattern since this is not an uncommon finding. One lesion in the left parietal lobe displays a small amount of enhancement suggesting it may represent a subacute plaque.