Clinical question: MS, new left hand tingling and stiffness. Signs and symptoms: Left hand tingling and stiffness, compared to previous exams. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities. Examination demonstrates no detectable abnormal parenchymal, meningeal, calvarial or retro-orbital enhancement.Examination demonstrates no evidence of any new lesions since prior exam. Previously noted enhancing plaques are again identified however without detectable enhancement on current study. A single lesion in the left middle cerebellar peduncle is again identified without enhancement however with subtle decreased size since prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Pre- and post enhanced cervical MRI:There are no prior cervical MRI exams for comparison.Examination demonstrate no convincing evidence of abnormal signal intensity, cord caliber or abnormal enhancement of the cervical and upper most visualized thoracic cord.There is no evidence of a spinal stenosis at any level.Very mild degenerative changes of cervical spine are noted however without detectable neural foraminal compromise at any level.
1.Pre- and post enhanced brain MRI demonstrate no evidence of new lesions or any detectable abnormal enhancement. Mild chronic changes of demyelinating disease is again noted with interval complete resolution of previously seen enhancement.2.Pre and post enhanced MRI of cervical spine demonstrate no convincing evidence of demyelinating disease or abnormal enhancement. No spinal stenosis or neural foraminal compromise.