Clinical question: MS, high burden of disease, concerning for new lesion, ataxia. Signs and symptoms: Ataxia. Pre and post enhanced brain MRI:There is difference of technique between the 2 exams which precludes precise comparison. There are 2 and 1 slice images on prior exam compared to 4 mm slice thickness on current study.Within this limitation examination redemonstrate fairly extensive findings of demyelinating disease in the periventricular and subcortical white matter of cerebral hemispheres, left thalamus and extensively in the midbrain and pons and including cerebellar peduncles and left cerebellum. Comparison with prior exam demonstrates no convincing evidence of progression of disease. Postcontrast images also demonstrate no detectable enhancing demyelinating plaques.Lateral ventricles are mildly prominent without change since prior exam and with maintained midline.Cortical sulci and CSF spaces are unremarkable and similar to prior exam.The signal void in major intracranial arterial branches are identified.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp.Unremarkable signal intensity of all visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities.
1.Extensive findings of demyelinating disease both in supra and infratentorial brain without convincing evidence of interval change. Please see above comments.2.No detectable abnormal enhancing plaques.3.Stable ventricular system, cortical sulci and CSF spaces since prior study.