Clinical question: Rule out multiple sclerosis. Signs and symptoms: Spasticity. Pre- and post enhanced brain MRI:No prior exams.Negative diffusion weighted series.Examination demonstrates very few small primarily periventricular foci of FLAIR hyperintensity which are nonspecific. On sagittal FLAIR images however few of these lesions demonstrate linear perpendicular appearance to the ventricular age is suggestive of demyelinating disease.There are no distinct lesions in the corpus callosum or the pons and cerebellar peduncles. None of the lesions demonstrate enhancement.Unremarkable anatomical morphology and with normal signal intensity of brain parenchyma otherwise on all MRI sequences. Unremarkable post enhancement series.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Pre- and post enhanced cervical MRI:Examination is severely degraded due to motion artifact which precludes precise assessment for subtle findings.Within the severe limitation there is no convincing lesion within the cervical cord.Post enhanced images also demonstrate no convincing evidence of abnormal enhancement however this sequence is also degraded due to motion artifact.There is uniform smaller than expected caliber of the spinal canal and highly suggestive of congenitally small canal/short pedicles. Mild degenerative changes of cervical spine is noted and with suggestion of mild left neural foraminal compromise at C3-C4, C4-C5 and moderate right neural foraminal stenosis at C6/C7.Pre- and post enhanced thoracic MRI:Patient examination demonstrates only a suspected focus of T2 hyperintensity in the dorsal aspect of thoracic cord extending from mid T4 to upper T5 level. Finding is best appreciated on sagittal T2 stair image 12 and axial T2 series 35 images 27-29 without evidence of abnormal enhancement. This finding is retrospectively detected on prior thoracic MRI exam from 3-12-15 on sagittal T2 STIR series 8 image 9 which also demonstrate decreased cord caliber at this site.No convincing evidence of any additional foci of cord signal abnormality. Mild degenerative changes however without evidence of central spinal stenosis are noted.
1.Pre and post brain MRI demonstrates primarily periventricular tiny foci of FLAIR hyperintensity some with perpendicular relation to the ventricular wall however without enhancement and suggestive of mild demyelinating disease. Unremarkable pre and postcontrast enhanced brain MRI otherwise.2.Pre- and post enhanced cervical MRI is degraded due to motion artifact. Within this location there is no convincing evidence of demyelinating plaque or abnormal enhancement. Uniformly small caliber of the spinal canal consistent with congenitally small canal/short pedicles. Mild degenerative changes with resultant neural foraminal compromise as detailed.3.Pre- and post enhanced thoracic MRI demonstrates a focus of T2 hyperintensity with decreased cord caliber and without enhancement extending from mid T4 to mid T5 levels as detailed above. Please see comments.