Findings:
Head:
Widespread foci of high FLAIR signal in the deep white, juxtacortical and subcortical white matter of both cerebral hemispheres, many of which are perpendicular to the corpus callosum. Further high T2/FLAIR signal focus is noted in the left cerebellar white matter. No involvement of the basal ganglia or the brain stem.
Several of the lesions show contrast enhancement; for example in the right frontal white matter, adjacent to the left posterior horn and in the left peritrigonal white matter.
The pituitary gland is normal.
The orbits, paranasal sinuses and mastoid air cells are clear.
Spine:
Intra medullary foci of T2 signal intensity are noted involving the cervical cord at C4/5 levels. No obvious further lesions could be identified.
Scoliotic deformity of the spine is seen. No disc herniation or relevant degeneration of the spine. The central canal and neural exit foramina are widely patent.
No paravertebral abnormality is identified.
Conclusion:
The appearances are consistent with widespread, advanced intracranial demyelination with several active lesions in both cerebral hemispheres.
Possible foci of demyelination also in the cervical cord at C4/5 levels.