MS versus NMO. Right lower extremity weakness and swollen blurred vision. Brain: There are greater than 15 T2/flair hyperintense lesions involving the periventricular and subcortical white matter, many of which demonstrate an ovoid pericallosal morphology and distribution consistent with known demyelinating disease. Few juxtacortical lesions are seen. There is clear evidence of progression with most of these lesions being new compared to remote MRI brain from 7/19/2007. Few of these lesions have associated T1 hypointensity. There is no significant parenchymal volume loss. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: There is a T2 hyperintense lesion involving the right dorsal cord at the C3 level which appears to be present on prior 2007 status study, although not well imaged on that motion degraded study. Otherwise, no new lesions within the cervical cord are appreciated. There is trace prominence of the central canal in the cervical cord.Vertebral body heights are maintained. There is some loss of normal cervical lordosis. There is no significant disk disease, spinal canal, or neural foraminal stenosis.Thoracic Spine:No T2 hyperintense lesions to suggest demyelinating disease are definitively appreciated in the thoracic cord. There is a tiny syrinx extending from the T2-T3 to the T9-T10 levels and measuring up to 2 mm at the T5 and T6 levels. There is otherwise normal caliber of the thoracic cord.Minimal degenerative changes are seen in the thoracic spine. No significant disk herniation, spinal canal or neural foramina stenosis is appreciated. Vertebral body heights are normal. There is mild straightening of the thoracic spine; alignment is otherwise maintained. Focus of T1 hyperintensity involving the T5 vertebral body is compatible with a hemangioma. No suspicious osseous lesions are seen.
1. Multiple, greater than 15, T2/flair hyperintense lesions in the supratentorial white matter with morphology and distribution consistent with demyelinating disease. There is evidence of progression compared to 2007 with most of the lesions appearing new since the remote study. As clinically questioned, appearance and distribution of these lesions is more typical of multiple sclerosis than those associated with NMO.2. Single T2 hyperintense lesion involving the right dorsal C3 cervical cord, which appears to be present on prior study from 2007, although less well imaged at that time. No new lesions in the cervical or thoracic cord are definitively appreciated.3. Small syrinx in the thoracic cord extending from T2-T3 to the T9-T10 levels and measuring up to 2 mm in the axial plane.