Neuromyelitis optica. Arm and leg weakness and numbness. The cervical spine images are limited by patient motion.Brain:A tiny noncontrast-enhancing, T2 hyperintense focus in the right parietal white matter is unchanged and nonspecific. Otherwise, the brain continues to show no focal abnormality. No evidence of acute infarct, hemorrhage, intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No hydrocephalus. No extra-axial collections. Bone marrow signal and extracranial soft tissues are unremarkable.Dedicated orbital MRI sequences were not obtained however no obvious signal abnormality is appreciated within the optic nerves on the brain MRI sequences. Mastoid air cells and paranasal sinuses are clear. Cervical Spine:Previously seen contrast-enhancing lesion in the right dorsal aspect of the cervical spinal cord at the C3 level no longer demonstrates contrast enhancement. Associated previously seen extensive T2 hyperintensity extending throughout the cervical cord has evolved with significant decrease in signal abnormality and cord swelling with development of mild volume loss. Sagittal images demonstrate patchy T2 signal abnormality involving the upper thoracic cord possibly worse in the interval but not well evaluated. No abnormal cord enhancement is appreciated. Cervical spine shows straightening but normal alignment otherwise. Vertebral morphology and marrow signal are normal. No significant spinal canal or neural foraminal stenosis. The left vertebral artery is small which is unchanged and may be related to hypoplasia.
1.Unchanged single focus of T2/FLAIR hyperintensity. No abnormal enhancement or findings to suggest NMO involvement of the brain. No evidence of acute infarct, mass, or mass effect. 2.Compared to 7/24/2012, there is been interval resolution of the previously seen enhancing lesion at the right C3 level as well as marked decrease in previously seen extensive cervical cord T2 hyperintensity and edema. Current study demonstrates residual T2 signal abnormality throughout the cervical cord, greater dorsally and on the right, with development of volume loss. Findings are consistent with sequela of prior myelitis. No abnormal enhancement is appreciated to suggest active disease.3.Patchy T2 signal abnormality is noted in the partially imaged thoracic cord on the sagittal T2 cervical cord sequences, possibly worse but not well-assessed. Dedicated thoracic spine MRI can be obtained as clinically appropriate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.