 There are numerous bilateral foci of increased T2/FLAIR signal in the brainstem, periventricular white matter, and deep white matter of bilateral hemispheres, left slightly greater than right. Multiple of these larger lesions in the periventricular white matter demonstrate low T1 signal centrally. The largest of these lesions, in the left frontal white matter measures 22 x 22 mm (series 801, image 17). These lesions are not associated with diffusion-restriction or abnormal enhancement. There are no extra-axial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain otherwise. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem, or cerebellar infarction. CERVICAL SPINE
1. Extensive T2 hyperintense lesions throughout the cerebral white matter, brainstem, and cervical spine compatible with multiple sclerosis. No abnormal enhancement is identified in these lesions. 2. Moderate degenerative changes at the C5/6 level.