60 years, Male, recent diagnosis of multiple sclerosis. New INO. Looking for progression of disease. Brain: There is moderate burden of T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. Relatively larger lesion is present in the posterior left frontal lobe. There are also multiple infratentorial lesions in the brainstem and cerebellar hemispheres. Lesions are also noted in the dorsomedial midbrain and upper pons including the region of the medial longitudinal fasciculus, particularly on the left which may explain patient's internuclear ophthalmoplegia.There is mild to moderate burden of T1 hypointense lesions. There is also mild parenchymal volume loss with mild thinning of the corpus callosum for age. There is no intracranial mass, mass effect, midline shift or herniation. No hydrocephalus.Cervical Spine: There are multiple T2 hyperintense lesions throughout the cervical cord with morphology and distribution consistent with known demyelinating disease. Relatively most prominent lesions are present at the C2 level involving the bilateral posterior aspects of the cord, right greater than left, as well as at the left ventrolateral C3-C4 level. There are additional small scattered lesions. Mild volume loss is present involving the dorsal cervical cord associated with the C2 lesions.Vertebral body heights and alignment in the cervical spine are normal. Minimal degenerative changes include small disc osteophyte complex, eccentric to the right at the C4-C5 level. There is no significant spinal canal stenosis at any level. Neural foramina are suboptimally evaluated due to motion degradation, but there does appear to be mild to moderate multilevel neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy, relatively worse at the right C4-C5 level.
1. Multiple supra- and infratentorial lesions as described above with morphology and distribution consistent with known demyelinating disease. No prior examinations are available for comparison and addendum can be issued if made available.2. Multiple demyelinating lesions in the cervical cord as described above, comparison of which is not available.