 BRAIN: There multiple supratentorial white matter lesions including within the periventricular and juxtacortical white matter. Some of these are new or increased in size while others have resolved or decreased in size. A single right cerebellar lesion is present and has decreased in size. Many the larger lesions again demonstrate T1 hypointensity. Many of the larger lesions also demonstrate new mild enhancement most prominent along the leading-edge. The overall lesion burden has increased. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. CERVICAL SPINE: There is a small new focus of T2 hyperintensity within spinal cord at C1-C2 level. There are unchanged foci of T2 hyperintensity at the C4-C5 level on the left and C5-C6 level on the right as well as multiple other questionable small foci of T2 hyperintensity. There is no associated enhancement of these lesions. The overall lesion burden has improved. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.
Multiple supratentorial, infratentorial, and cervical spinal cord lesions as detailed above are compatible with history of multiple sclerosis. The overall supratentorial lesion burden has increased with multiple new and newly enhancing lesions. The infratentorial and cervical spinal cord lesion burden has improved.