Right lower extremity weakness, Multifocal scattered various sized high signal intensity lesions on FLAIR imaging are seen on bilateral frontal lobes, parietal lobes and corpus callosum. Especially on sagittal FLAIR scan, those high signal intensity lesions appear to be arranged as per periventricular to ventricle. On gadolinium enhancement, there is a focal enhancing nodule on the right precuneus which may indicate active lesion.Above findings suggest possibility of demyelinating disease such as multiple sclerosis.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. 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.C spine MRI:Again, there are multifocal patch high signal intensity lesions on the spinal cord, especially at the level of C2-C3 and T1-T2 junction level with minimal cord expansion indicating possible edema. On gadolinium enhancement, C3-C4 level as well as T1-2 junction region show patch or periportal enhancement indicating active lesion. Considering multifocal white matter lesions on brain MRI, the spine MRI findings are consistent with spinal cord involvement of demyelinating disease such as multiple myeloma.The cranial-cervical junction is normal. There is straightening of spica spine losing normal lordotic angle. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. 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.From C2-C3 to T1-2 level, there is no evidence of neural foraminal or spinal canal stenosis.
Multifocal patchy high signal intensity lesions on bilateral hemispheres as well as spinal cord (cervical spine) as described above. There are some enhancing lesions on gadolinium enhancement mostly on cervical spinal cord. These findings suggest possibility of multiple sclerosis with active plaques. Clinical and laboratory [CSF study] correlation are recommended.