Reason: r/o new demyelinating lesions History: stiffness, confusion MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a moderate degree of periventricular and subcortical white matter lesions which are hyperintense on T2 and flair sequences. Many of these lesions are perpendicular to the lateral ventricles. There is a lesser degree of posterior fossa white matter lesions present in the brain stem. There are enhancing foci present in the periventricular white matter adjacent to the frontal horn of the right lateral ventricle and the periventricular white matter adjacent to the right ventricular trigone. There are a couple subcortical white matter enhancing foci in the left middle frontal gyrus there and additional punctate focus of contrast enhancement is present in the subcortical white matter of the right precentral gyrus medially.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 cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a redemonstration of cord signal hyperintensity along the right posterior lateral aspect of the spinal cord at the C3 vertebral body level, the right posterolateral aspect of the spinal cord at the C4 vertebral body level,at the left hemicord at the C3 vertebral body level and the posterior spinal cord at the C5-6 level.Since the prior exam the patient has undergone anterior fusion from C3 through C6. Compared previous effacement of spinal fluid ventral and posterior the spinal cord at C3-4 and C4-5 has improved. There is no spinal stenosis appreciated on the current exam.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.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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. No abnormal foci of enhancement are appreciated in the thoracic spinal cord.There is T2 signal hyperintensity in the thoracic spinal cord at the right posterior and lateral aspect of the spinal cord at the T3-4 level, along the right hemicord at the the T6 and T7 vertebral levels There is artifact which partly obscures visualization of the spinal cord at the T9 level..There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.There are small pleural effusions present
1.Enhancing lesions located in the left and right frontal lobe subcortical white matter as well as along the periventricular white matter adjacent to the right lateral ventricle are suspected to represent acute plaque formation. There are multiple white matter lesions scattered predominantly and supratentorial brain but also infratentorial brain are compatible with patient's diagnosis of demyelinating disorder. These are mostly similar compared to the prior exam.2.Multiple cervical spinal cord lesions are stable compared to prior exam and are compatible with patient's diagnosis of demyelinating disorder. 3.Status post cervical spine surgery with reduction of spinal stenosis4.Thoracic spinal cord lesions are present which are compatible with patient's diagnosis of demyelinating disorder. These were not clearly identified on the prior exam5.There are small pleural effusions present