Oct 26, 2010
Summed up. C-spine and T-spine clear of lesions.
MRI of the brain without contrast due to chronic headaches and pain in eyes- Age 30 impression: Very tiny punctuate area of white matter hyperintensity in the left frontal region which is non-specific. There are some prominent CSF (Virchow-Robin) spaces but I see no cortical infarct. I see no evidence of acute intracranial event.
MRI of the brain with and without contrast to check for MS - Age 35 impression: No acute enhancing demyelinating foci. There are a few scattered tiny white matter foci of increased signal intensity on FLAIR and T2-weighted sequences mainly stable from 2003. Interval development of 2 non-acute non-enhancing white matter foci are seen in the frontal lobe regions.
MRI of the brain with and without contrast to check for MS - Now, age 37 findings (more detail): There are numerous small white matter lesions scattered within the supratentorial brain parenchyma. These are all less than 5mm without mass or abnormal enhancement. There is no abnormal diffusion signal. The white matter lesions are peripherally located in the juxtacortical white matter.
Impression: There are numerous small white matter lesions scattered within the supratentorial brain parenchyma, predominantly in the juxtacortical white matter with no mass effect or abnormal enhancement. These are nonspecific and differential considerations for a patient this age would include sequela of chronic infectious or inflammatory process, collagen vascular diseases, or less likely demyelinating disease. Follow-up examination in 3 to 6 months would confirm stability of these lesions. Neurologic consultation is recommended.
Feb. 2010: Abnormal enhancement associated with a small lesion in the subcortical medial left parietal lobe compatible with active demylination. (I wrote this on the forum but I'm unable to find the paper at the moment. I'm sure I will soon. This is when I started with ON.)
March 2010 orbit study: There is questionable faint enhancement associated with the intraorbital segment of the left optic nerve, extending through the orbital apex into the pre-chiasmatic segment. There is slight effacement of the CSF around the optic nerve in the nerve sheath on the coronal T2 images in the region of the orbital apex of the left. This is asymmetric compared to the right. However the optic never is not obviously enlarged. Findings are compatible with mild optic neuritis. Further clinical correlation and followup recommended.
Parenchyma: Scattered subcortical white matter lesions are again demonstrated. Faint enhancement associated with the white matter lesion in the left parietal lobe is stable. No new enhancing abnormalities.
Oct. 2010: Bad grammar, punctuation, and spelling, but here it goes! There a few nonspecific T2 FLAIR foci periventricular subcortical white matter which are stable from prior study. These foci are nonenhancing and are imperceptible on T1. Although nonspecific, these foci could be consistent with provided history of multiple sclerosis.
Impression: Stable MRI the brain with nonspecific T2 FLAIR foci and paratracheal subcortical white matter. These foci do not meet imaging criteria for multiple sclerosis however, multiple sclerosis remains in the differential diagnosis. There are no new, enhancing, or diffusion positive foci seen.