48 years, Female, multiple sclerosis and gait disorder. Brain: There is a moderate burden of T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution consistent with known demyelinating disease. There is extensive confluent signal abnormality in the periventricular and pericallosal region. There is mild to moderate burden of T1 hypointense lesions. There is also brain parenchymal volume loss which is advanced for age with diffuse thinning of the corpus callosum. There is fairly mild involvement of the posterior fossa but with abnormal signal in the bilateral paramedian midbrain including along the medial longitudinal fasciculus, the paramedian ventral medulla, and along the right aspect of the cerebellar vermis with associated volume loss. No intracranial mass effect, midline shift, or herniation. No hydrocephalus or extra-axial collections. Visualized calvarium and extra cranial soft tissue structures are grossly unremarkable.Cervical spine:There is a T2 hyperintense lesion involving the dorsal paramedian cervical cord at the mid C2 level. There are more subtle tiny lesions suspected involving the left dorsolateral C2 and left lateral C3 levels as seen on the axial T2 and mFFE sequence as well as one involving the right dorsolateral C6 level. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. There is a small central disc protrusion at the C5-C6 level There is no significant spinal canal or neural foraminal stenosis.
1. Findings consistent with known demyelinating disease with moderate burden of supratentorial lesions and to a lesser degree in the infratentorial brain as described above.2. Few small T2 hyperintense lesions in the cervical cord are suspected as described above.