46 years, Female, paresthesias. Evaluate for demyelinating lesions. Brain: There are approximately 10 T2/FLAIR hyperintense lesions involving the periventricular and subcortical white matter. Many of these lesions are noted to be in a periventricular, perpendicular orientation as well as along the callososeptal interface highly suspicious for demyelinating disease. Although differences in technique limiting precise comparison, there are relatively larger lesions such as involving the posterior callosal body as well as the right parietal subcortical white matter which are convincingly new since prior. Few lesions with T1 hypointensity are also noted. Brain parenchymal volume is preserved. No intracranial mass or mass effect. No midline shift or herniation. Small bilateral maxillary mucus retention cysts are again seen.Cervical spine: Again seen is a T2 hyperintense lesion involving the cord in the dorsal midline at the C3 level, which is slightly decreased in size and compatible with evolution. No new lesion is definitively appreciated compared to 7/10/2015.Vertebral body heights in the cervical spine are normal. There is mild reversal of cervical lordosis at the C4-C5 level, which may be in part positional. Again seen is generalized T1 hypointensity involving the bone marrow signal which is nonspecific but can be seen in conditions such as chronic anemias. No discrete destructive osseous lesions are demonstrated. Mild multilevel degenerative changes are again seen including a disc extrusion at the C4-C5 level which contacts the ventral cord, without high-grade spinal canal stenosis overall at this level and similar to prior. Neural foramina throughout the cervical spine are patent.
1. Multiple T2/FLAIR hyperintense lesions in the supratentorial white matter are highly suspicious for demyelinating disease. Although differences in technique limit comparison, there does appear to be progression since 7/14/2015. For example, there are new lesions involving the right callosal body and right parietal lobe subcortical white matter. 2. Dorsal C3 cord lesion, which demonstrated enhancement on prior study, demonstrates slight decrease in size since 7/10/2015 and compatible with evolution. No new lesions within the cervical cord are appreciated.3. No significant change in disc extrusion at the C4-C5 level, which contacts the ventral cord without associated cord signal abnormality.