MRI BRAIN WITH AND WITHOUT CONTRAST:
CLINICAL HISTORY: 35-year-old man with decreased acuity in the right
visual field.
FINDINGS:
BRAIN:
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.