Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: w/u for spinal cord lesions, ddx broad History: bilateral hand the foot numbness, subjective perianal and peroneal numbness Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There are multiple scattered high signal intensity lesion on FLAIR/T2 on bihemispheric white matter including periventricular white matter, centrum semiovale, left side midbrain, bilateral corpus callosum splenium, left putamen and the left middle cerebellar peduncle. On gadolinium enhancement, there are multiple punctate enhancing lesions including left superior parietal lobule, left side corpus callosum splenium and right angular gyrus (best seen on sagittal post enhanced scan).Constellation of above findings indicate underlying demyelinating disease such as multiple sclerosis with a couple of active plaques.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The right maxillary sinus show a retention cyst.Cervical and Thoracic spine MRI:There are multiple patchy high signal intensity lesions on cervical spinal cord at the level of C2, C3, C4, without definitive evidence of cord swelling. On post Gad enhanced images, there is focal nodular enhancement on the posterior aspect of the spinal cord lesion located at the level of C3.On thoracic cord, there is linear high signal intensity at the level of T56. Suspicious cord lesion with high signal intensity on STIR images was also seen at the level of T11, but was not definitively identified on axial scan.Cervical lordosis and thoracic kyphosis appear to be normal.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The conus medullaris terminates at the level of T12L1.
Multifocal intracranial and spinal especially cervical spinal white matter high signal intensity lesions with some nodular enhancing lesions. These findings suggest possibility of demyelinating disease such as multiple myeloma involving both brain parenchyme and spinal cord with some active plaques. 