Clinical question: MS; follow-up progression. Signs and symptoms: Paresthesias. Nonenhanced brain MRI:There is significant technique difference between the current exam performed with dedicated multiple sclerosis protocol with 2 mm slices compared to prior routine brain MRI with 5 mm slices.Within this limitation examination demonstrates a small demyelinating plaque in the inferior right pons similar to prior exam. Unremarkable images through posterior fossa otherwise. Images through the supratentorial space demonstrate mild findings of demyelinating disease in the periventricular and subcortical white matter of cerebral hemispheres without convincing evidence of any new lesions. Questionable subtle interval decreased size of a previously known lesion in the subcortical white matter of the right posterior temporal lobe.Normal size of cortical sulci, ventricular system and patent all CSF spaces similar to prior study.Nonenhanced cervical MRI:Examination at C5-C6 demonstrate a right lateral disc extrusion with resultant subtle flattening deformity of the ventral aspect of the cord and mild central spinal stenosis. There is a small focus of T2/T2 STIR hyperintensity of the anterior aspect of the cord at this level (sagittal T2 STIR series 1201 image 8 and 9) which is suspected for a a focus of myositis secondary to disc herniation, however considering patient's history of demyelinating disease possibility of the lesions representing a demyelinating plaque cannot be entirely excluded.There are tiny additional suspected foci of T2 hyperintensity within the cord on axial T2 series 1301 on image #30 in the right posterior cord at C2 level, left posterior cord on image 27 at C3 level, image 24 on the right at C3-C4 level, left posterior on image 22 at C4 level.The caliber of the cord remains within normal.Minimal degenerative changes at other levels however without evidence of spinal canal or neural foraminal compromise.Upper most visualized thoracic cord and thoracic spine T3 level are unremarkable.
1.Mild supratentorial findings of demyelinating disease without definitive change since prior exam and a single right inferior pontine lesion as well as noted on prior study.2.MRI of cervical spine demonstrate a right lateral disc extrusion at C5-C6 level with resultant subtle flattening deformity of the ventral aspect of the cord on the right and mild central spinal stenosis. Small focus of T2 hyperintensity of the anterior cord at the level of disc extrusion which could represent a focus of myelitis however possibility of a demyelinating plaque cannot be entirely excluded. Multiple tiny additional foci of T2 hyperintensity of the cord as detailed or level above and suspected of demyelinating disease. Unremarkable exam otherwise.