Imaging & Reports

Purpose of This Section

This section provides a centralized reference to key imaging studies and diagnostic reports relevant to the case. Imaging findings are summarized factually, with emphasis on longitudinal changes and clinically relevant observations.

Original reports and images are referenced where available to support independent review.

Neuroimaging

Brain MRI (Multiple Studies, With and Without Contrast)

  • Recurrent imaging demonstrates periventricular and subcortical white matter hyperintensities consistent with demyelinating disease

  • Interval progression of lesion burden noted across serial studies

  • New lesions identified on more recent imaging without corresponding enhancement

  • No consistent evidence of active demyelination on recent examinations

  • Brainstem and cerebellum generally preserved

  • Stable small extra-axial enhancing lesion consistent with meningioma, under surveillance

These findings have been interpreted as compatible with multiple sclerosis, though correlation with symptom burden remains an area of interest.

Spinal Imaging

Cervical Spine MRI

  • Postsurgical changes consistent with prior anterior cervical discectomy and fusion (C5–C7)

  • Multilevel disc bulging and spondylotic changes

  • Mild to moderate thecal sac and foraminal narrowing at select levels

  • No convincing demyelinating lesions identified within the cervical spinal cord

Thoracic Spine MRI

  • Mild multilevel degenerative changes

  • No abnormal cord signal or enhancement

Lumbar Spine MRI

  • Mild degenerative disc disease, most notable at L5–S1

  • Mild facet arthropathy

  • No significant spinal canal stenosis or nerve root compression

  • Incidental benign intraosseous hemangioma identified

Endocrine Imaging

Pituitary MRI

  • Preoperative imaging demonstrated pituitary adenoma with growth hormone excess

  • Postoperative imaging confirmed successful resection

  • No evidence of recurrent mass on follow-up studies

Thoracic and Other Imaging

Chest CT

  • No acute pulmonary pathology identified

  • Prior small pulmonary nodule no longer visualized on follow-up imaging

  • Incidental healed rib fracture noted on later study

Cardiovascular and Autonomic Testing

Transthoracic Echocardiogram

  • Normal cardiac structure and function

  • Normal left ventricular ejection fraction

  • No significant valvular disease

Tilt Table Testing

  • Mild transient blood pressure changes during upright positioning

  • Symptoms reproduced without arrhythmia

  • Findings not diagnostic for classic neurocardiogenic syncope

Imaging Summary and Observations

Across studies, imaging demonstrates:

  • Objective evidence of central nervous system demyelination with progression over time

  • Structural spinal changes without clear cord-level demyelination

  • Endocrine pathology successfully addressed surgically

  • Limited imaging correlates for the severity and persistence of pain and neurologic symptoms

The relationship between radiographic findings and clinical progression remains an area of interest for further expert interpretation.

Availability of Reports

Where possible, original radiology reports and relevant documentation are available for review in PDF format. Imaging summaries are presented to aid orientation and do not replace independent evaluation of original studies.