ClariPACS

Neuro_MR_Brain: 35 M, decreased right visual acuity.

MRI BRAIN WITH AND WITHOUT CONTRAST:
 
CLINICAL HISTORY: 35-year-old man with decreased acuity in the right 
visual field.
 
FINDINGS:
 
BRAIN:
 
Parenchyma: There are multiple T2 hyperintense foci in the juxtacortical and periventricular white matter. Periventricular lesions are oriented perpendicular to the ventricles with some lesions extending into the corpus callosum. Additional patchy lesions are seen in the brainstem. Several lesions demonstrate hypointensity similar to CSF on T1 images. Multiple lesions demonstrate enhancement, with smaller lesions demonstrating solid nodular enhancement, and larger enhancing lesions demonstrating incomplete rim enhancement most notable in the anterior right temporal lobe. Of note, there is a rim-enhancing lesion along the left optic tract proximal to the lateral geniculate nucleus, which may account for patient's symptoms. No definite restricted diffusion, with increased signal seen on diffusion-weighted images and lesions related to T2 shine through. No acute hemorrhage or mass effect.

Ventricles and extra-axial spaces: Appropriate for age. Cavum septum pellucidum et vergae incidentally noted.

Orbits: No definite optic nerve signal or abnormal enhancement to suggest optic neuritis. However, there is enhancement along the posterior left optic tract as above noted, additionally, there is increased signal along the proximal right optic tract, without enhancement postcontrast.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: None.

INTRACRANIAL ANGIOGRAM:
 
Anterior circulation: No flow-limiting stenosis or aneurysm.
 
Posterior circulation: No flow-limiting stenosis or aneurysm.
 
Dural venous sinuses: Patent.
 
Additional comment: None.
 
PERFUSION:
Normal.
 
IMPRESSION:
 
1.  Multiple ovoid juxtacortical and periventricular white matter lesions, and brainstem lesions typical of demyelination, specifically multiple sclerosis. Several lesions demonstrate enhancement compatible with active demyelination. Active lesion involving the posterior left optic tract may account for patient's right visual field symptoms. Signal abnormality is also seen in the proximal right optic tract without abnormal enhancement. No optic nerve signal abnormality or enhancement. Recommend completion of neuraxis imaging with contrast-enhanced MRI of the cervical and thoracic spine.

(MS with active demyelination)


Accession: CL27388356

Study description: MR BRAIN WITH AND WITHOUT CONTRAST

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