Encephalomyelitis. Evaluate for change of the inflammatory CNS lesions. Also headache and back pain.Additional clinical history from electronic medical records: 14 year old girl with a complex past medical history including a multi-system autoimmune disease which is thought to be caused by a mutation of the CTLA4 pathway who presented with brain and spine lesions on previous MRI. BRAIN:The few contrast-enhancing left frontal lobe lesions on the prior examination have resolved. Associated T2-hyperintensity is significantly improved to resolved. T2-hyperintense lesion in the left parietal white-matter with associated volume loss remains unchanged. The other smaller foci of T2-hyperintensity in the occipital lobes and in the right frontal lobe as well as the posterior corpus callosal body are also unchanged. These lesions are noncontrast enhancing. There is apparent faint focal contrast enhancement in the right frontal white-matter but no definite correlate on the coronal postcontrast imaging or T2/FLAIR, and may be artifactual. Otherwise, there is no new brain lesion and no abnormal intracranial contrast enhancement. Focus of susceptibility effect overlying the left frontal lobe is unchanged, related to previous biopsy. Otherwise, there is no acute intracranial hemorrhage. There is no acute infarct.Accounting for mild ex vacuo ventricular and sulcal enlargement in the left parietal region, the ventricles and other CSF-containing spaces are fairly symmetric. There is no mass-effect or midline shift. The major intracranial vascular flow voids are preserved.The orbits, skull and scalp are grossly unremarkable accounting for expected findings of previous left frontal lobe lesion biopsy. There is mild mucosal thickening in the maxillary and ethmoid sinuses.COMPLETE SPINE:There has been remarkable improvement of the expansile T2-hyperintense lesion involving the lower cervical/upper thoracic spinal cord. Residual abnormality is located predominantly on the left side at at T1-T2 level and is faint and subtle. The associated cord expansion is almost resolved. Associated contrast enhancement is remarkably improved.The remainder of the spinal cord is unremarkable. The sagittal spinal alignment is anatomic. There is a mild broad-based right convex curvature which can be positional. The vertebral bodies are preserved in height. The marrow signal is also unremarkable.Small lymph nodes in both sides of the neck are not enlarged by size criteria. The patient is intubated. Lungs show dependent abnormality likely reflecting atelectasis.
1.Left frontal lobe brain contrast enhancing lesions have resolved with improvement of the associated T2-hyperintensity. Other T2-hyperintense lesions remain unchanged, most pronounced in the left parietal lobe, with associated volume loss but no contrast enhancement or diffusion restriction, probably represent gliosis/chronic sequela of the previous, resolved inflammatory lesions. 2.Faint focal contrast enhancement in the right frontal white-matter on axial imaging does not correlate with abnormality on the other sequences or on the coronal postcontrast imaging and is likely artifactual. Otherwise, there is no definite new brain lesion.3.There is also marked decrease in size and enhancement of the upper thoracic spinal cord lesion.