Female, 37 years old, with intractable headache. Approximately 10 T2 hyperintense lesions are identified located predominantly in the periventricular regions and corpus callosum, though there are several in the juxtacortical white matter as well. The largest lesion is within the left centrum semiovale. Several lesions demonstrate a radial orientation with respect to the ventricles. The remainder of the brain demonstrates relatively normal morphology. No evidence of significant parenchymal edema or mass effect is seen. Overall parenchymal volume is within acceptable limits. No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.On MRA imaging of the head, no significant intracranial vascular stenosis or occlusion is identified. No aneurysms are suspected. The region of the ACOM artery is within normal limits. Large bilateral PCOM arteries are seen. The right P1 segment is hypoplastic.
1. Multiple white matter lesions are seen with a distribution and morphology which are highly suggestive of demyelinating disease, though other etiologies including gliosis, sequelae of prior inflammation, and vasculitis can be entertained.2. No significant vascular abnormality is detected.3. No prior examination is available at the time of this dictation. If prior exams can be made available, we will be happy to compare and make an addendum to this report.