Male, 37 years old, history of MS, with new right face weakness, left third nerve palsy, left ptosis and bilateral internuclear ophthalmoplegia for two days. Brain:Scattered T2 hyperintense lesions are redemonstrated within the white matter of the bilateral cerebral hemispheres. As before, the largest lesion is present in the right parietal periatrial white matter. There has been no significant interval change in the size and number of these lesions when compared to the prior exams.As before, a very small focus of T2 hyperintensity and questionable restricted diffusion is again seen within the dorsal pons, just to the right of midline along the floor of the fourth ventricle. No significant interval change is seen.No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. There are no abnormal extra axial fluid collections or evidence of intracranial hemorrhage. The ventricular system remains normal in size and morphology.IACs:The visualized cranial nerves demonstrate normal morphology and are free of pathologic enhancement. The fluid-filled structures of the inner ears demonstrate normal morphology.Orbits:The globes are round and symmetric. The extraocular muscles demonstrate normal morphology and signal characteristics. The optic nerves are normal in course morphology and show no evidence of pathologic focal signal abnormality. Postcontrast images are motion degraded, but within this limitation, no definite pathologic intraorbital enhancement is seen.
1.Multiple scattered cerebral white matter lesions are redemonstrated, appearing similar to prior examinations and consistent with demyelinating disease.2.A small area of T2 and diffusion signal abnormality is redemonstrated along the dorsal pons, in the location of the medial longitudinal fasciculus. Given the history of MS, this may represent a small demyelinating lesion which could potentially account for the patient's internuclear ophthalmoplegia.3.Within the limitations of imaging artifact, no definite abnormalities of the cranial nerves or orbits are seen.