Findings:
Head:
Generalized cerebral and cerebellar atrophy, thinning of the corpus callosum and ventriculomegaly inappropriate to the patient’s age. There is no midline shift.
Multi-focal areas of infra- and supra-tentorial high T2/FLAIR signal predominantly within the periventricular white matter. Further demyelinating plaques are noted involving the right thalamus, the pons, the right middle cerebellar peduncle, both cerebellar hemispheres and the medulla oblongata. The lesions show no barrier disruption or diffusion restriction.
The pituitary gland is normal.
Mucosal thickening is seen in the left maxillary sinus. Minimal mucosal thickening is also seen in the right frontal and the left ethmoid and sphenoid sinuses. The mastoid air cells are clear.
No bony abnormality is seen.
Cervical spine:
Intramedullary foci of the myelination are noted involving the posterior aspect of the medulla oblongata and upper cervical cord, the anterior aspect of the cervical cord at C2 level, the left lateral aspect of the cervical cord at C3/4 level, as well as the anterior aspect of the thoracic cord at T4 level. The lesions show no enhancement on the postcontrast study.
The vertebral bodies and discs are of normal height with no malalignment. The marrow and disc signal is normal.
The central canal and neural exit foramina are widely patent. No paravertebral abnormality is identified.
Conclusion:
Advanced multiple sclerosis with involvement of the cerebral and cerebellar hemispheres, the pons and the medulla oblongata with volume loss and thinning of the corpus callosum.
Multiple MS plaques involving the cervical and upper thoracic cord. No evidence of any active lesions.