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Had MRI and fourth ventricle is midline. What are the findings from the report?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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I went to NYU and had another Mri without contrast to follow the nonspecific ill defined bilateral lesions I had since 2011. The report is as follows.
The fourth ventricle is midline. There is no evidence of midline shift or mass effect. The size of the ventricular system and sulcal pattern is within range of normal for patients stated age. There is no evidence of intraparenchymal hemmorrhage. No significant extra axial collections are noted.
On the Flair and t2- weighted sequences there are fairly symmetric areas of t2 signal hyperintensity seen within the posterior aspect of the pons bilaterally. These are best seen on axial images #8 through #10 of series #4 and 6. There is also a punctate area of t2 hyperintensity within the subcortical white matter of the left frontal lobe as well as slight punctate t2 hyperintensities within the periventricular white matter adjacent to the frontal horns bilaterally.
The appearance of the t2 hyperintensities within the pons are non specific. Given the symmetric nature one consideration would be prior infectious/inflammatory process. Another consideration would be osmotic myelinolysis if the patient had previous metabolic abnormality. These could also represent areas of demyelination, however, there is no pattern of periventricular of corpus callosal t2 hyperintensities to further suggest demyelinating process other than slight punctate t2 hyperintensities adjacent to frontal horns. Another consideration would be prior ischemic change although there is no findings to suggest additional areas of ischemic change within the basal ganglia. Clinical correlation is requested. There is no evidence of diffusion abnormality to suggest acute ishemic event.
Normal flow voids are mantained within the XXXXXXX cartoid arteries bilaterally as well as within the vertebral basilar system.
Impression:
There are symmetric areas of t2 hyperintensity seen within the pons with differential as discussed above. There is no evidence of acute ishemic event.
There is no evidence of focal mass lesions or intracranial hemorrhage.
Please note my CRP is .86 and my ESR is 27
Posted Fri, 8 Nov 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 2 hours later
Brief Answer:
My reply is below

Detailed Answer:
Hi,
Thank you for posting your recent MRI report.

It is reassuring to note that the current MRI does not show any significant changes as compared to the last MRI done in 2011.

Since you are not on any specific treatment for multiple sclerosis (MS), it is very unlikely to be MS now. This is because MS would progress in a span of two years if someone is not on treatment.

Also, the current MRI does not show any active disease. As per the report, the lesions seen are old lesions, which could occur with inflammation, ischemia or demyelination. The MRI is not specific for any of the three diseases.

CRP is high, but ESR is almost normal. High CRP is suggestive of inflammatory systemic disease, but your rheumatologist has not found any of them. So, the diagnosis is still open. If any further signs or symptoms develop, then, a diagnosis could be made with certainty. As of now, you require only symptomatic treatment.

I hope it helps. Please get back if you have any follow up queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
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