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Age: 38

Sex: Female

Indication: Bilateral lower extremity weakness

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Case #13


Findings

  • Multiple T2/STIR hyperintense, short segment lesions in the cervical spinal cord including a midline dorsal lesion at the level of C1, a left lateral lesion at the level of C2-C3, a left dorsal lesion at the level of C3, a right lateral lesion at the level of C5-C6, a left lateral lesion at the level of C6, and a right ventrolateral lesion at the level of C7-T1
  • Associated focal intramedullary enhancement on the left at C2-C3 and on the right at C6
  • Normal cord contour and volume
  • Small disc bulges and mild uncovertebral hypertrophy at C4-C5, C5-C6, and C6-C7 without significant spinal canal or neural foraminal stenosis
  • Normal alignment
  • Normal marrow signal


Diagnosis

  • Multiple sclerosis

Sample Report

Multiple T2/STIR hyperintense, short segment lesions in the cervical spinal cord including a midline dorsal lesion at the level of C1, a left lateral lesion at the level of C2-C3, a left dorsal lesion at the level of C3, a right lateral lesion at the level of C5-C6, a left lateral lesion at the level of C6, and a right ventrolateral lesion at the level of C7-T1. This appearance is most consistent with a demyelinating process, particularly multiple sclerosis. Enhancement associated with lesions on the left at C2-C3 and on the right at C6 suggests active demyelination. Recommend brain MRI with and without contrast to assess for intracranial disease.

Mild multilevel degenerative changes without significant spinal canal or neural foraminal stenosis.


Discussion

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Images

Multiple short segment T2/STIR hyperintense lesions in the cervical spinal cord (red arrows) in this patient with multiple sclerosis. Enhancement associated with two of these lesions (red arrows) concerning for areas of active demyelination.



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