Clinical question: Right eye optic neuritis symptoms, history of MS, right arm numbness. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination redemonstrates minimal chronic nonenhancing changes of demyelinating disease and supratentorial brain parenchyma without convincing evidence of change/progression since prior study. Unremarkable anatomical morphology and signal intensity of brain parenchyma otherwise on all MRI sequences and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.Normal signal intensity of the calvarium and soft tissues of the scalp without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Pre and post enhanced cervical MRI:Examination is degraded due to motion artifact and suboptimal for detection of subtle findings.Within this limitation there is normal signal intensity and caliber of cervical and without enhancement.The upper most visualized thoracic cord however demonstrate a focus of T2 hyperintensity in the anteriorly at T3-T4 disc level (sagittal T2 STIR series 1701 image 11). This finding demonstrate no change in the caliber of the cord or abnormal enhancement. Prior cervical MRI from 2013 did not include this region and there are no prior thoracic spine MRIs.There is normal signal intensity and alignment of vertebral column without spinal stenosis or neural foraminal compromise.
1.Brain MRI demonstrate stable mild chronic findings of demyelinating disease in the supratentorial brain parenchyma and unremarkable otherwise.2.Cervical MRI demonstrate a single nonenhancing lesion in the anterior thoracic cord at T3-T4 disc level and unremarkable otherwise.