Sudden onset lower extremity weakness and numbness. Assess for demyelinating disease. BRAIN MRI:No signal abnormalities are seen in the brain to suggest demyelinating disease. There is a small pineal cyst measuring up to 10 mm which is incidentally noted. Brain parenchyma is otherwise unremarkable. There is no acute infarct or intracranial hemorrhage. There is no mass-effect or midline shift. There is no abnormal extra-axial fluid collection. There is no abnormal intracranial contrast enhancement. The major intracranial vascular flow voids are preserved. There is a retention cyst in the inferior aspect of the left maxillary sinus. The orbits are unremarkable. There is no destructive skull lesion.CERVICAL SPINE MRI:The study is limited by patient motion.There is T2-hyperintense, T1-hypointense signal within the central spinal cord from C5-C6 level and extending caudally into the upper thoracic spine. While the lower end of the abnormality is not included on the current exam, it is probably an extension of the previously described similar abnormality of this thoracic spine, which on February 27, 2016 ended cranially at T1-T2 level. There is no definite abnormal contrast enhancement.Otherwise, there is straightening of the cervical spine and minimal disc desiccation but no significant degenerative disease otherwise. There is no spinal canal or neural foraminal stenosis. There is minimal dependent atelectasis in the lungs.
1.No evidence of demyelinating disease in the brain.2.There is nonenhancing T2 hyperintensity in the lower cervical cord extending into the upper thoracic cord which appears to be increased in the cranial direction when compared to thoracic MRI from 2/27/2016. Differential remains broad. Finding may represent progression of myelitis (inflammatory or demyelinating), increased edema associated with the thoracic lesion, with ischemic injury not excluded. No additional lesions are seen in the upper or mid aspect of the cervical cord to suggest a background of chronic demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.