Diagnosis: Altered mental status, unspecified. Multiple sclerosisClinical question: Evaluate for etiology of altered mental status, somnolenceSigns and Symptoms: worsening MS, altered mental status, somnolence The CSF spaces are appropriate for the patient's stated age with no midline shift. T2 and FLAIR hyperintense and T1 hypointense periventricular and subcortical white matter lesions of a moderate degree are present, some of which are perpendicularly oriented to the lateral ventricles. Similar lesions are also present in the brain stem and cerebellum. There are also T2/FLAIR signal hyperintense lesions present in the medial thalami, the right precuneus gray matter and the right superior frontal gyrus gray matter.Sagittal FLAIR imaging suggests a FLAIR hyperintense lesion in the cervical spinal cord at the C3-4 level without any evidence of enhancement on the postcontrast sagittal T1 images.No abnormal enhancing mass lesions are appreciated intracranially. 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 demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Multiple lesions scattered throughout the brain predominantly in the white matter as detailed above support the clinical history of demyelinating disorder. There are no enhancing lesions appreciated to suggest acute demyelinating plaque.2.Findings suggest possible demyelinating focus in the cervical spinal cord at C3-4