 BRAIN: There is a large confluent region of T2 hyperintensity within the right frontal and parietal subcortical and deep white matter centered around the central sulcus. There is mild associated T2 hyperintensity of the corticospinal tracts extending into the internal capsule posterior limb. There is no associated mass effect, susceptibility effect, diffusion restriction, or enhancement. There is no evidence of intracranial hemorrhage acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: There is abnormal T2 hyperintensity extending the length of the spinal cord but most prominent in the cervical region extending from C2 through C7 where there is cord expansion. There is a 3-mm rounded focus of intramedullary enhancement within the conus at the L1 level. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at L2. The paravertebral soft tissues are unremarkable. The bladder is distended.
Large confluent focus of signal abnormality involving the right frontal and parietal white matter as well as signal abnormality throughout the spinal cord, most prominent within the cervical cord where there is cord expansion. These findings are most compatible with a demyelinating process such as ADEM. Follow-up is recommended to ensure improvement. 