Clinical question: MS evaluate disease burden, compared to 2013 study. Signs and symptoms: Myoclonus, right sided paresthesia cognitive issues, imbalance to the left. Pre-and post enhanced brain MRI:No diffusion weighted abnormalities.Examination redemonstrates chronic nonenhancing findings of multiple sclerosis in the periventricular and subcortical as well as the corpus callosum of mild degree. Minimal similar findings are also present in the pons. When compared with prior exam there is no convincing evidence of any change of findings in the supratentorial space however there is mild progression of disease in the pons with evidence of a new nonenhancing plaque.The cortical sulci and ventricular system as well as the CSF spaces remain within normal for patient stated age of 61 and is stable since prior exam.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Under local images through the orbits, paranasal sinuses and mastoid air cells.Pre-and post enhanced cervical MRI:There are no prior exams for comparison.Examination demonstrates only questionable small foci of T2 hyperintensity in the left paramedian cord at C5 and C6 levels without detectable abnormal enhancement are caliber and signal intensity of the cord is otherwise within normal.There are mild to moderate degenerative disk disease in particular at C5 -- C6 and C6 -- C7 levels. The findings result in moderate left and mild right neural foraminal compromise at C5 -- C6 and significant bilateral neural foraminal compromise at C6 -- C7 levels. Mild central spinal stenosis at C6 -- C7.There is slight straightening of cervical lordosis likely secondary to degenerative disease.There is no detectable abnormal enhancement the vertebral column.Pre-and post enhanced thoracic MRI:There is normal signal intensity and caliber thoracic cord and without abnormal enhancement.There is normal signal intensity and alignment the vertebral column without abnormal enhancement.There is no evidence of spinal canal or significant neural foraminal compromise at any level. Hypertrophy changes of posterior elements at T8 -- T9 however results in mild to moderate left neural foraminal compromise.Three limited partial visualization of L1 -- 2 disk level demonstrates very extensive degenerative disk disease with significant loss of disk height and extensive spur formation. There are no prior lumbar spine imaging for comparison. Correlate with history and symptomatology and considered dedicated MRI of lumbar spine if clinically deemed necessary.
1.Pre-and post enhanced brain MRI demonstrate no evidence of an acute enhancing demyelinating plaque. Stable mild chronic multiple sclerosis in the supratentorial brain parenchyma since prior exam. Minimal findings of chronic demyelinating disease in the pons and with evidence of minute interval progression since prior outside institution MRI exam from 2013. 2.Pre-and post enhanced MRI of the cervical spine demonstrate only questionable tiny nonenhancing foci of T2 hyperintensity at C5 and C6 which could also be result of degenerative changes. Degenerative changes at C5 -- C6 and C6 -- C7 levels results in mild central spinal stenosis at C6 -- C7 level and with significant bilateral neural foraminal compromise.3.Unremarkable pre-and post enhanced MRI of the thoracic spine. At the very edge of the field of exam there is partial visualization of significant disk disease at the L1 -- L2 level and with extensive bony formation. Correlate with history neurological findings and considered follow-up with dedicated lumbar MRI if clinically deemed necessary.