Thyroid eye disease versus multiple sclerosis: diplopia. Orbits: The bilateral inferior rectus muscles are enlarged, particularly on the right side, where there is hyperenhancement and edema. The right medial rectus muscle may also be slightly enlarged. In addition, there is mild crowding towards the right orbital apex without evidence of optic nerve compression. Indeed, the bilateral optics nerves appear to be intact, without evidence of signal abnormality or contour deformity. There is no evidence of orbital mass lesions or abnormal enhancement. The optic nerves display normal signal and morphology. The globes and ocular adnexa are unremarkable. The orbital walls appear to be intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a mildly ectatic and tortuous right vertebral artery. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.
1. Findings suggestive of thyroid associated orbitopathy, with inflammatory changes involving the right inferior rectus muscles and mild crowding of the right orbital apex, but no discernible optic nerve impingement. 2. No evidence of demyelinating lesions.