Clinical question: MS flare up. Signs and symptoms: Lower extremity weakness. Pre and post enhanced cervical MRI:Examination demonstrates extensive T2 and in particular T2 STIR patchy foci of hyperintensity throughout the cervical and thoracic cord. There is no convincing evidence of enhancement and no definitive evidence of change in cord caliber.Examination of cervical region demonstrate normal anatomical alignment of vertebral column and moderate degenerative changes of the spine.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrates degenerative changes without spinal stenosis or neural foraminal compromise.C4-C5 demonstrate moderate degenerative changes with resultant moderate right and mild left neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate moderate disc disease and loss of disc height, a right lateral disc protrusion with resultant subtle mass effect on the cord and mass effect on the exiting right nerve root. Mild central spinal stenosis, moderate right neural foraminal compromise and mild on the left.C6-C7 demonstrate mild degenerative changes and a shallow broad-based central disc protrusion with expected enhancement. This finding also results in partial effacement of ventral subarachnoid space and subtle flattening deformity of the cord and mild central spinal stenosis. Mild right neural foraminal compromise is also present.C7-T1 is unremarkable.Pre- and post enhanced thoracic MRI:Examination similar to cervical spine demonstrate fairly extensive patchy T2 and T2 STIR hyperintensity of the cord without convincing evidence of enhancement. There is a short segmental focus of decreased cord caliber in the lower thoracic region suggestive of volume loss. Finding consistent with patient's history of demyelinating disease.The signal intensity in the alignment of the vertebral column is within normal and without evidence of spinal canal compromise or stenosis at any level.Pre- and post enhanced lumbar MRI:The lower most visualized thoracic cord and conus demonstrate patchy T2 STIR hyperintensity without abnormal enhancement.There is normal signal intensity and alignment of vertebral column.Degenerative changes at L3-L4 including degenerative disc disease and hypertrophic changes of posterior elements results in moderate central spinal stenosis and moderate to severe right neural foraminal compromise. No spinal stenosis at any other level.
1.Extensive T2 and more noticeably T2 STIR hyperintense signal intensity changes throughout the cervical and thoracic cord without convincing detectable abnormal enhancement consistent with patient's history of demyelinating disease. There is a short segmental decreased lower thoracic cord caliber consistent with volume loss.2.Degenerative changes of cervical spine and including disc protrusion with resultant central spinal stenosis and neural foraminal compromise as detailed above.3.No significant degenerative changes of thoracic spine and no evidence of central spinal stenosis.4.Degenerative changes of the lumbar spine with resultant moderate central spinal stenosis only at L3-L4 level as detailed above.