dysesthesia in the limbs, assess for demyelinating disease Brain MRI:There are multifocal scattered asymmetric bihemispheric more likely punctate or nodular high signal intensities on FLAIR images.High signal intensity lesions were seen on white matter and subcortical white matter of bilateral frontal, parietal and temporal lobes.These lesions do not show perpendicular arrangement, however, considering the patient's age, likelihood of being "nonspecific small vessel disease" is unlikely. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine:The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.
1. Multifocal bihemispheric white matter high signal intensity lesions on FLAIR images as described above. Demyelinating disease is a diagnostic possibility and non specific small vessel disease is unlikely.2. Cervical spine MRI is within normal limits 