Diagnosis: Multiple sclerosisClinical question: CNS demyelinationSigns and Symptoms: Numb legs Cervical spine:There is T2 signal hyperintensity within the cervical spinal cord along the long segment along the posterior and left paramedian aspect of the spinal cord extending from the cervical medullary junction down to the C4-5 level. There is smaller T2 hyperintense lesions in the cervical spinal cord one measuring a couple millimeters in size along the left posterior lateral aspect of the spinal cord at the C6-7 level additional T2 hyperintense lesions are present in the thoracic spinal cord.There is patchy T2 signal hyperintensity present within the visualized portion of the pons and medulla.The cervical vertebral bodies are appropriate in overall alignment and height. There is loss of disc space height at C4-5, C5-6 and C6-7 and to some degree at C3-4. There is disc desiccation present throughout the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy. There is encroachment of the right-sided exiting nerve roots within the neural foramina. There are some subacute acute endplate reactive changes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge as well as endplate and uncovertebral osteophytes at this level and mild ligament flavum hypertrophy.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:Multiple patchy T2 hyperintense lesions are present in the thoracic spinal cord. There is a generalized spinal CORD atrophy present. There is T2 and T1 signal hyperintensity present within the T5 vertebral body with the CT findings on 6/27/2012 suggestive of vertebral body hemangioma.There is anterior compression fracture present T2 12 which can also be identified on the CT scan from 6/27/2012 and does not appear to have changed substantially. Additionally there is compression fracture at L1 and L2 with exaggeration of the normal lumbar lordosis which is also stable.The thoracic vertebral bodies are appropriate in the overall alignment. There is no compromise of thoracic spinal canal or exiting nerve roots.
1.There are multiple lesions scattered in the cervical and thoracic spinal cord associated with cord atrophy. This may be suggestive of demyelination. Additionally there are signal changes within the visualized brainstem which are also suggestive of demyelination.2.There are compression fractures present in the upper lumbar and lower thoracic spine which have been stable since prior CT exam from 2012.3.There is encroachment of the right-sided exiting nerve roots at C4-5 due to degenerative changes. The multilevel degenerative changes present in the cervical spine.