Clinical question: Evaluate for MS flare up. Signs and symptoms: Increased number of falls. Pre and post enhanced brain MRI:There are no prior MRI exams for comparison with this study.No diffusion-weighted abnormalities.Examination demonstrate diffuse periventricular and corpus callosum, subcortical, cortical, right cerebral peduncle, left middle cerebellar peduncle and right paramedian medulla foci of FLAIR hyperintensity consistent with patient's known demyelinating disease. There is detectable enhancement of multiple demyelinating plaques in the right posterior frontal cortex, right anterior frontal white matter, right periventricular white matter and right posterior temporal white matter suggestive of demyelinating plaques. No prior exams for comparison.There is a slight uniform prominence of cortical sulci, lateral ventricles and cerebellum-millimeter folia for patient's stated age.The signal void in the major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series.With the exception of a small retention cyst in the right maxillary sinus are paranasal sinuses and bilateral mastoid air cells, middle ear cavities demonstrate normal pneumatization signal patterns.
1.Finding consistent with chronic and acute demyelinating disease as detailed above. There are no prior MRI exams for accurate assessment of progression.2.Subtle prominence of cortical sulci, lateral ventricles, cerebellum and vermian folia for age.3.Unremarkable exam otherwise.