Female 25 years old with history of ascending numbness There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter primarily within the frontal and parietal lobes. Additional lesions noted within the bilateral posterior limbs of the internal capsule, adjacent to the right temporal horn, and posterior fossa including the bilateral right greater than left cerebral peduncles. The right middle cerebral peduncle lesion is located near the trigeminal nerve root entry zone.Thinning of the periventricular white matter in the bilateral parietal regions as well as a diminutive posterior corpus callosum noted. There is mild to moderate dilatation of the lateral and third ventricles and relatively normal size of the fourth ventricle. Cerebral aqueduct is grossly patent.No midline shift or herniation. The calvarium and extracranial soft tissues are grossly unremarkable.
1. Multiple supratentorial and infratentorial T2/FLAIR hyperintense lesions in the brain with a distribution suspicious for chronic demyelinating disease. These lesions do not demonstrate enhancement to suggest active demyelination.2. Dilatation of the third and lateral ventricles with grossly patent cerebral aqueduct. There is significant thinning of the parietal-occipital white matter and the posterior corpus callosum. Overall findings are favored to represent chronic hydrocephalus (favored communicating hydrocephalus, less likely but possible low-grade obstruction at the cerebral aqueduct). The thinning of the white matter is favored to be related to the long-standing hydrocephalus although possibility of perinatal injury resulting in the white matter volume loss remains and can be correlated with history.