Diagnosis: Other visual disturbances Anesthesia of skin Multiple sclerosisClinical question: MS evolution, suspect acute relapse, R arm numbness, R eye pain blurrinessSigns and Symptoms: ms evolution, suspect acute relapse, R arm numbness, R eye pain blurriness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of T2 and FLAIR signal hyperintensity present along the gray-white interface at the medial and superior aspect of the right cingulate gyrus along its more posterior aspect. There is no associated enhancement following gadolinium administration. There is no associated diffusion restriction. It is subtly hypointense on T1.There is a T2 and FLAIR signal hyperintense lesion present adjacent to the temporal horn of the left lateral ventricle and lateral to it. There is no associated enhancement following gadolinium administration. It is hypointense on T1-weighted imaging.A couple punctate foci of signal loss and susceptibility weighted imaging are present one in the left temporal lobe and one in the left frontal periventricular white matter.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is a signal hyperintense focus present along the posterior aspect of the spinal cord at the C1-2 level. This is not associated with enhancement following contrast administration. There is some mild multilevel disc desiccation present.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There is a cervical spinal cord lesion along its posterior aspect at C1-2 which is suspicious for a focus of demyelination.2.There is no MR evidence to support an assessment of optic neuritis.3.There is a right cingulate gyrus lesion present and a left temporal lobe lesion which are nonspecific in isolation. It is quite possible that these are related to demyelination given the patient's clinical history.4.A couple microhemorrhages are present in the left hemisphere which in isolation are nonspecific.5.There are mild degenerative changes present in the cervical spine worse at C3-4 related to disc bulge.6.Exam is somewhat compromised due to patient motion especially in the postcontrast sequences which may obscure more subtle abnormalities.