Clinical question: New neuro symptoms in pt with known MS off Tecfidera x 2 weeks and JC virus positive; PML vs. MS flare. Signs and Symptoms: paresthesias, headaches, vision changes. Pre and post enhanced brain MRI:There is technique difference between the current routine brain MRI (4 mm slices) and prior dedicated protocol with 2 mm slices.Within this limitation examination demonstrate no definitive change in the extent of the mild chronic nonenhancing supratentorial demyelinating disease since prior exam. A single tiny focus of FLAIR hyperintensity in the left hemispheric white matter without enhancement also remain similar to prior exam and likely representing additional benign lesion.The cerebral cortex, cortical sulci, ventricular system and CSF spaces are within normal for stated age of 43. Negative post contrast images.Unremarkable images through the orbits including axial fat sat post enhanced series.Normal pneumatization signal patterns of all paranasal sinuses and bilateral mastoid air cells.
Stable mild chronic nonenhancing demyelinating disease since prior exam as detailed. Please see above comments.