Clinical question: Assess for MS. Signs and symptoms: Assess for MS. Nonenhanced brain MRI:Negative diffusion weighted images.Sagittal images demonstrate herniation of cerebellar tonsils through the foramen magnum for approximately 7.5 mm and result in mild flattening deformity of the dorsal aspect of tarsal. No change since prior exam from an outside institution exam (Northwest community Hospital) dated 7-23-14.Examination demonstrates a single ill-defined small focus of subtle FLAIR hyperintensity in the left paramedian pons and without interval change since prior exam.Anatomical morphology and the signal intensity of brain parenchyma remains otherwise within normal on all MRI sequences. In particular there are no detectable lesions in the corpus callosum, subcortical or periventricular white matter or in the cerebellar peduncles.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are normal.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.Partial opacification of right chamber of the sphenoid sinus and unremarkable paranasal sinuses otherwise.
1.Negative diffusion weighted images.2.Herniation of cerebellar tonsils through the foramen magnum of approximately 7.5 mm with mild flattening deformity.3.Single ill-defined nonspecific focus of FLAIR hyperintensity in the left paramedian pons and unremarkable nonenhanced brain MRI otherwise and without evidence of demyelinating disease.4.No evidence of interval change since prior exam from 7-23-14.