Clinical question: Worsening vision on the right, tingling right hand, burning sensation in both legs, weakness and legs, gaite problem. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates extensive tiny foci of flair hyperintensity in bilateral subcortical, periventricular white matter of city hemispheres and minimally in the posterior fossa. Findings consistent with patient's previously known multiple sclerosis. There is no significant interval change since prior exam on the extent of the above findings and none of the lesions demonstrate enhancement to suggest active demyelinating plaque.Ventricular system and cortical sulci remain within normal size and without evidence of any intracranial mass effect. The calvarium is unremarkable. Images through the orbits including axial fat sat series are unremarkable and without convincing evidence of abnormal enhancement.Pre-and post-enhanced MRI of orbits:Examination demonstrate normal signal intensity and caliber of the optic nerves bilaterally. There is no convincing evidence of enhancement of optic nerves. The optic chiasm demonstrate normal signal intensity and without detectable abnormal enhancement.There is normal signal intensity of the retro-orbital fat. The signal intensity, caliber and pattern of enhancement the extraocular musculature is also within normal.Lacrimal glands are within normal size and morphology and without detectable abnormal enhancement.Pre-and post-enhanced cervical MRI:Examination demonstrates fairly extensive foci of T2/T2 stir hyperintensity throughout the cervical cord and minimally in the uppermost visualized thoracic cord. Although difficult to precisely compare with prior exam due to technique difference there is suggestion of interval progression of disease. Examination however demonstrate no convincing evidence of an enhancing plaque.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild asymmetric right uncovertebral hypertrophic changes and a small central disk protrusion without spinal stenosis or neural foraminal compromise.C4 -- C5 demonstrates a prominent central and right paramedian broad-based disk protrusion which results in effacement of ventral subarachnoid space and slight flattening and posterior displacement of the cord resulting in mild central spinal stenosis. Mild bilateral neural foraminal compromise is also present.C5 -- C6 demonstrate degenerative changes resulting in moderate right neural foraminal compromise.C6 -- C7 demonstrate large asymmetric left uncovertebral hypertrophy, shallow broad-based disk protrusion and mild bilateral ligamentum flavum hypertrophic changes. Constellation of changes results in mild central spinal stenosis without convincing evidence of neural foraminal compromise.
1.Pre-and post-enhanced brain MRI demonstrate moderate supratentorial and mild infratentorial chronic findings of multiple sclerosis no abnormal enhancement or significant change since prior exam.2.Pre-and post-enhanced MRI of the orbits is unremarkable. 3.Pre-and post-enhanced MRI of cervical spine demonstrate extensive chronic findings of demyelinating disease with interval progression since prior exam. Large central disk protrusion at C4 -- C5 with resultant mild central spinal stenosis is noted. Degenerative changes and a shallow disk protrusion at C6 -- C7 with resultant mild central spinal stenosis. Neural foramina are compromised as detailed per level.