Diagnosis: Multiple sclerosisClinical question: please do Dr Javed MS protocol and compare to priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple subcortical white matter lesions present without associated contrast enhancement which are high signal on FLAIR and low signal on T1 at the left inferior frontal gyrus and the left superior frontal gyrus. These are stable.There are a couple subcortical white matter lesions present without associated contrast enhancement which are high signal on FLAIR and intermediate signal on T1 at the right inferior frontal gyrus (stable) and the right middle temporal gyrus (new).No abnormal enhancing mass lesions are appreciated intracranially. 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 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.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 disk dessication and a disk bulge at this level associated with end plate osteophytes. This is stable since the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication and a disk bulge at this level. There are end plate reactive changes present. These findings are stable since the prior exam.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.Some subcortical white matter lesions are stable since the prior exam and are non-specific on MRI.2.There are minor degenerative changes in the cervical spine. There are no stigmata of demyelination identified in the cervical spinal cord. 