Diplopia [H53.2] / Multiple sclerosis [G35], Reason for Study: ^Reason: r/o new lesions History: double vision Brain MRIMultifocal various sized patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale are seen. Considering the difference of imaging technique and MR machine, the number and distribution appear to be stable and unchanged. However, on today's scan, there is focal FLAIR high signal intensity at the posterior aspect of mid pons adjacent to the anterior wall of the 4th ventricle at the level of middle which is more conspicuous than prior scan. There is about 5mm caudal herniation of cerebellar tonsil.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIMotion artifacts degraded exam quality.There is normal cervical lordosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. There broad based disc protrusion central to left which abuts thecal sac at C67. However, there is no evidence of spinal canal stenosis or neural foraminal stenosis.Other intervertebral disc levels appear to be normal.
1. Multifocal various size bihemispheric periventricular white matter and centrum semiovale FLAIR/T2 high signal lesions consistent with multiple sclerosis lesions, unchanged since prior scan.2. More conspicuous FLAIR high signal posterior aspect of mid pons could be related to technical differences, however, clinical correlation is recommended.3. Broad based disc herniation central to left at the level of C67 without evidence of spinal canal stenosis. 