Female, 58 years old, with weakness and paresthesias. Evaluate for demyelinating disease. Brain:Numerous foci of white matter T2 hyperintensity are seen in the bilateral cerebral hemispheres ranging in size from punctate up to about 7 mm in diameter. A few of these lesions are periventricular in location but most are found in the more peripheral subcortical white matter. The morphology of these lesions is nonspecific. No discrete lesions are seen within the corpus callosum. With the exception of a punctate focus of signal abnormality in the pons, the posterior fossa structures are also spared.No evidence of restricted diffusion, parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. There is no evidence to suggest intracranial hemorrhage. The ventricles and sulci may be very slightly prominent for age but this is an equivocal finding.Bone marrow signal characteristics are unremarkable. Extensive paranasal sinus mucosal inflammatory disease is noted.Cervical spine:Evidence of instrumented anterior spinal fusion is seen at C5-6. Laminectomy has also been performed bilaterally from C3 through C7. These surgical findings are unchanged.Also unchanged is a band of T2 hyperintensity within the dorsal spinal cord at the C5-6 level which likely represents myelomalacia as the cord is thinned through this region. There may also be mild linear T2 hyperintensity tracking longitudinally within the cord at the C3 and C4 levels, also unchanged. No evidence of any new spinal cord lesion is seen.Reversal of the normal cervical lordosis is a stable finding. Degenerative endplate signal alteration is seen at C3 and C4, but no worrisome or destructive marrow lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Decompression of the spinal canal. No significant foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation. Decompression of the spinal canal. Mild bilateral foraminal narrowing. C5-6: Disc space is not well visualized due to artifact from orthopedic instrumentation. Decompression of the spinal canal. No significant foraminal narrowing. C6-7: Decompression of the spinal canal. The neural foramen are not well visualized due to motion artifact. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic spine:Allowing for some image degradation by motion artifact, no spinal cord lesions are seen. The spinal cord demonstrates normal morphology throughout.A very slight scoliotic curvature of the thoracic spine is seen. Sagittal alignment is anatomic. Marrow signal characteristics are somewhat heterogeneous but without any aggressive or worrisome findings.Loss of disc height is seen from T3-4 through T9-10. Disc bulging is also evident at T6-7, T7-8 and T9-10 resulting in at most mild spinal canal narrowing. The T9-10 neural foramina are also likely narrowed to a mild degree. Elsewhere, no significant spinal canal or neuroforaminal stenosis is seen.
1.Numerous scattered T2 hyperintense lesions are seen within the cerebral white matter. A majority of these lesions are located peripherally in the subcortical white matter and the morphology of the lesions is nonspecific. Of note, the corpus callosum is completely spared. These imaging findings would not be typical for multiple sclerosis, though an atypical demyelinating process should still be considered. Other etiologies, including vasculitic, inflammatory and granulomatous processes, can also be considered.2.Evidence of extensive surgery is seen in the cervical spine including anterior fusion of C5-6 and bilateral laminectomy from C3 through C7. The spinal canal is widely decompressed through the operative region. A focus of encephalomalacia is seen within the spinal cord at the C5-6 level which is unchanged compared to the prior examination. The nature of this lesion is uncertain. Correlation with preoperative imaging would be helpful in this regard. There may be minimal T2 hyperintense signal within the cord above the C5 level, but this is also unchanged. No new cervical cord lesions are seen.3.No evidence of any focal spinal cord lesion is seen in the thoracic spine.4.Degenerative findings are evident in the cervical and thoracic spine with details as indicated above.