Multiple sclerosis [340], Reason for Study: ^Reason: multiple sclerosis flare History: left leg motor and/or sensory cortex. Also occular symptoms, ataxia Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal somewhat patchy high signal intensity lesions on FLAIR images on bilateral periventricular white matter extending toward subcortical white matter with perpendicular to ventricular wall appear to be consistent with multiple sclerosis lesion. Since most of those lesions show tissue losses on T1 weighted images, high signal intensity lesions on FLAIR images could represent burn out lesions.There is no evidence of abnormal enhancement.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-Spine:There are multifocal various sized some linear and some nodular high signal intensity lesions (most prominent on C3 level) on cervical spinal cord as well as brain stem on T2 and STIR images indicating demyelinating lesions.There is minimal bulging of disc at the level of C34, otherwise unremarkable.No abnormal enhancement.Thoracic Spine:There are linear and slightly patchy increased signal intensities especially mid to lower thoracic spinal cord indicating demyelinating lesions.Intervertebral discs are unremarkable.Neural foramen and spina canal are unremarkable.No abnormal enhancement.Lumbar Spine:There is patchy high signal intensity lesion on the conus on T2 weighted image indicating demyelinating lesion. The spinal cord completed at the level of T12-L1.There is intervertebral disc dessication at the level of L5S1 with minimal central protrusion which abuts thecal sac.Small (5.5mm) perineural cyst on the right side of likely S4 root.No abnormal enhancement.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Multiple non enhancing high signal intensity lesions on FLAIR images with evidence of corresponding tissue losses indicate possible burn out lesions of multiple sclerosis. Comparison of prior scan might be helpful for more precise evaluation of each lesion activity. 3. Multifocal patchy and some nodular high signal intensity lesions involving thoracic and lumbar spinal cords on T2 images indicating demyelinating lesions.4. Disc protrusion with disc dessication at the level of L5S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.