Neurosarcoidosis. Brain: There are postoperative findings to right transfrontal biopsy. There is increased confluent subcortical white matter T2 hyperintensity in the right middle frontal gyrus and bilateral occipital lobe periventricular regions, but decreased white matter signal abnormality elsewhere in the brain. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are persistent diffusely prominent intramedullary veins in the bilateral cerebral hemispheres, but no abnormal leptomeningeal enhancement. There are also scattered areas of gyriform intrinsic T1 hyperintensity, particularly in the occipital lobes, which may represent cortical laminar necrosis. The ventricular system appears to be slightly dilated throughout. There is no midline shift or herniation. Pituitary: The pituitary and infundibulum are not enlarged and there is no evidence of intrasellar lesions. The cavernous sinuses and optic apparatus are intact.
1. Interval evolution of the cerebral white matter abnormality with some areas that are more greatly affected than before and other areas that have improved and no evidence of recurrent leptomeningeal disease.2. No evidence of recurrent pituitary or infundibular involvement.3. Mild dilatation of the ventricular system, which may be a sequela of neurosarcoidosis and/or treatment effects.4. Findings suggestive of scattered cortical laminar necrosis, but no evidence of acute infarction.