Female, 34 years old, with Hashimoto's encephalopathy, assess for structural damage. Scattered foci of cortical restricted diffusion are seen involving both cerebral hemispheres. Since the prior examination, some previous lesions have diminished or resolved while other lesions are new. T2/FLAIR hyperintensity is evident correlating to these areas of restricted diffusion and as with the diffusion findings, many of these areas are new from prior. Of note, progressive T2 FLAIR signal abnormality is seen within the cerebral peduncles.Encephalomalacia affecting a majority of the right parietal, occipital and temporal lobes, as well as a portion of the left occipital and left parietal lobes is unchanged from prior. These findings result in ex vacuo dilatation of the ventricular atria.Minimal gyriform enhancement in the right temporal lobe is unchanged. No new parenchymal or extra-axial pathologic enhancement is seen.No evidence of any significant intracranial hemorrhage or abnormal extra-axial fluid is demonstrated. Ventricular size and morphology are not significantly changed.
1.Interval fluctuation of the size and number of cortical diffusion restricting lesions with interval decrease or resolution of some previously seen lesions and interval development of new lesions.2.Large areas of encephalomalacia are redemonstrated showing no significant interval change and representing sites of prior diffusion restricting disease.