Female, 34 years old, with one episode of right lower extremity numbness, and now with right T6-T10 numbness, urinary incontinence, and new headaches. Brain:A 6 mm enhancing lesion is evident along the roof of the right lateral ventricular body without significant mass effect. No additional enhancing lesions are seen. However, at least 10 scattered foci of T2/FLAIR hyperintensity are seen within the bilateral periventricular white matter, particularly clustered in the parietal regions, with additional focal lesions in the right pons and left brachium pontis. None of these lesions shows significant enhancement, but rather, several demonstrate conspicuous T1 hypointensity.No evidence of any significant parenchymal edema or mass effect is seen. Brain parenchymal volume is preserved. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.Thoracic spine:There may be a slight scoliotic curvature of the thoracic spine, but this could also be positional. Sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement, enhancement or edema are seen.A suggestion of T2 signal abnormality is noted within the left lateral cord at the C6-7 level, though this is evident on the first slice of the sequence only and may therefore be artifactual. More convincing T2 hyperintensity is seen within the right lateral cord at the T5 level, extending in the CC dimension for approximately one vertebral body length. No convincing pathologic spinal cord enhancement is observed.The intervertebral discs are preserved. No significant bulge or herniation is seen. The spinal canal and neural foramina are patent.
Multiple white matter lesions are identified in the brain involving the periventricular regions bilaterally and the pons. One lesion, along the roof of the right lateral ventricle, demonstrates enhancement, while the remainder do not.Also noted is a nonenhancing T2 hyperintense lesion within the right lateral spinal cord which spans approximately one vertebral body in length. There may be an additional lesion in the left lateral cord at C6-7 but this is suboptimally evaluated.The above findings are most likely to represent demyelinating disease. The possibility of some other inflammatory or autoimmune process would be less likely.