50 year-old female with history of multiple sclerosis presenting with paresthesias. Brain:Again seen are multiple white matter T2 hyperintensities in a primarily subcortical distribution in the supratentorial brain and pons. Patient motion on both today's scan and the prior examination mildly limits comparison, but within this limitation no definite new lesions are identified and the existing lesions are not significantly changed. Only the largest lesion which is located in the left occipital lobe is associated with decreased T1 signal. No significant cerebral volume loss.In the skull base there appears to be anomalous vessel arising from the mildly ectatic junction of the cavernous and petrous right internal carotid connecting to the basilar artery, traversing the dorsum sellae. This is just above the level of the trigeminal nerve. The slightly focally ectatic cavernous carotid mildly remodels the dorsum sella on the right side. There is no evidence of intracranial hemorrhage or mass. 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. The orbits are unremarkable.Cervical spine:The cervical spinal cord is normal in caliber and contour throughout. No evidence of myelomalacia. No evidence of demyelinating disease. The vertebral body and intervertebral disc heights are maintained. There is minimal multilevel decreased intervertebral disc signal compatible with early desiccation. There is straightening of the lower cervical lordosis which may be positional or degenerative in etiology. No bone marrow signal abnormalities.There are very minimal disc osteophyte complexes at C3-4, C5-6, and C6-7 without significant neural foraminal or spinal canal stenosis. Thoracic spine:Again seen are patchy poorly defined areas of increased T2 signal within the proximal thoracic spinal cord. This is most notable in the ventral cord at the lower T1 level as well as in the right lateral cord at the T3 and T4 levels. A more focally defined plaque of increased T2 signal within the central to posterior spinal cord at the T9-10 level measures 3 x 3 x 12 mm, previously 3 x 3 x 11 mm. There is mild volume loss associated with the T9-10 lesion. These findings are not significantly changed from prior and no new lesions are identified.The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. There are small right paracentral disc protrusions at T5-6 and T6-7. There is mild spinal canal stenosis with flattening of the anterolateral cord T6-7. No significant neural foraminal stenosis.
1. Stable findings of multiple sclerosis in the brain with multiple demyelinating lesions in the supratentorial brain and pons. Accounting for differences in techniques, these lesions are not significantly changed and no new lesions are identified. Overall, trace T1 and mild T2 burden of disease, including infratentorial lesions.2. Stable findings of demyelinating disease with patchy areas of abnormal T2 signal in the proximal thoracic cord as well as a more defined focal plaque at T9-10. No new lesions are identified.3. Anomalous vessel in the skull base likely representing a persistent trigeminal artery with associated ectasia of the right cavernous carotid artery, and associated remodeling of the dorsum sella which is a common finding. This can be further evaluated with MR angiography.4. No evidence of demyelinating disease in the cervical spine.