Follow-up of mildly restricted diffusion lesion on prior MRI, numbness and tingling of the right upper extremity, possible demyelinating disease. There is no evidence o acute ischemic or hemorrhagic lesion on today's scan.There is no evidence of abnormal enhancement either.Previously recognized left inferior frontal area mildly restricted diffusion lesions are not demonstrated on today's scan. However, corresponding high signal intensity lesions on FLAIR images are seen and do not show any significant interval change since prior exam (series 5, image18/38).Previously seen focal high signal intensity on vermis on FLAIR imaging (series 8, image 21/30) appears to be much lessen signal intensity than prior scan.Above findings could represent evolution of small subacute ischemic lesions or could also represent evolving demyelinating lesion. Again there is no evidence that can suggest chronic demyelinating lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. There is no evidence of acute ischemic or hemorrhagic lesion.2. Non visualization of previously recognized restricted diffusion lesions on the left inferior frontal lobe but can still recognizable on FLAIR images. Lessen signal intensity and smaller in size of the anterior vermis lesion on FLAIR images without evidence enhancement. Again diagnostic possibilities include evolving subacute ischemic lesions and demyelinating lesions. Follow up imaging study and clinical correlation might be valuable for the differential diagnosis.