Patient with history of multiple sclerosis presenting with left leg weakness. Brain: Again noted is a moderate burden of periventricular and subcortical white matter T2/FLAIR hyperintense lesions, consistent with patient's known demyelinating disease and unchanged as compared to the prior exam. Multiple of these lesions are associated with marked T1 hypointensity, similar to prior exam. Additional lesions in the corpus callosum and left cerebral hemispheres are unchanged. No abnormal enhancement is noted within the lesions. No intracranial hemorrhage identified. The ventricles and basal cisterns are normal in size and configuration. Brain volume is within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Postoperative changes of previous sinus surgery are noted. Cervical spine:FLAIR signal abnormalities are noted within the anterior and posterior aspect of the spinal cord at the C2 level, along with right posterior aspect of the cord at the C6 level, suggestive of demyelinating disease. No associated enhancement is identified. A couple of additional small lesions may be present but are equivocal.Alignment is anatomic. Vertebral body heights are preserved. There is a central disc osteophyte complex at the level of C6-C7, resulting in mild spinal canal stenosis and foraminal narrowing. Additionally, small disc osteophyte complexes are present at the C4-C5 level with mild foraminal narrowing as well as mild foraminal narrowing at the C3-C4 level are seen. Facet joints are hypertrophied at multiple levels.Thoracic spine:Image quality is reduced by patient motion. Given these limitations, no definite cord abnormalities are identified. Alignment is anatomic. Vertebral body is intervertebral disc spaces are preserved. No disc herniations or spinal canal stenoses are identified. Incidental note is made of the T9 vertebral body hemangioma.
1. Multiple periventricular and subcortical white matter T2/FLAIR hyperintense lesions with no contrast enhancement, compatible with patient's known history of demyelinating disease, stable as compared to prior exam.2.2 to 3 areas of cord signal abnormality in the cervical spinal cord, suggestive of demyelinating disease with no associated enhancement.3.Thoracic spine images are degraded by patient motion. Given these limitations, no definite thoracic spinal cord abnormalities are identified.