Female, 41 years old, with history of multiple sclerosis presenting with neuropathic pain, headaches, blurred vision, bilateral hand and leg numbness. Brain:Numerous T2 hyperintense lesions are demonstrated in the juxtacortical and periventricular white matter of the cerebral hemispheres, the corpus callosum, and to a lesser degree the brainstem and cerebellum. In some areas the periventricular lesions are nearly confluent. Many of the lesions demonstrate a relatively angular morphology suggesting chronicity. Most lesions demonstrate mild to moderate T1 hypointensity. A large C-shaped left frontal lesion, however, demonstrates marked T1 hypointensity. Despite the lesion burden, brain volume is relatively well preserved and the corpus callosum is only mildly thinned. No mass effect is seen. No abnormal extra-axial collections are appreciated. Ventricular size and morphology are within normal limits.Cervical spine:Numerous scattered foci of cord T2 hyperintensity are seen throughout the cervical spine distributed primarily in the dorsal and lateral aspects of the cord. Slight cord volume loss is seen in association with several of the lesions.Straightening of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is seen. Minimal posterior disc-osteophyte complex formation is seen along with thickening of the PLL. No significant spinal canal stenosis is detected.Thoracic spine:Evaluation of the thoracic cord is compromised by motion artifact. Nevertheless, numerous scattered foci of abnormal cord signal are suspected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal. No pathologic marrow replacement is seen. The intervertebral discs are preserved. No compromise of the spinal canal or neural foramina is detected.
1.Extensive white matter disease is seen intracranially compatible with the stated history of multiple sclerosis. Many of these lesions demonstrate a relatively angular morphology which would indicate chronicity.2.Numerous scattered lesions are also seen in the cervical and thoracic spinal cord compatible with multiple sclerosis.