Gait abnormality, paresthesias. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter. Lesions include one adjacent to the right temporal horn as well as involving the lateral aspect of the middle cerebellar peduncle on the left including the nerve root entry zone of the left trigeminal nerve. Susceptibility effect noted in the left lateral middle cerebellar peduncle and along the lateral pons on the left. Few ovoid lesions perpendicular to the ventricle are also seen. Small focus of susceptibility measuring 4 mm is seen involving the right posterior frontal lobe, compatible with chronic microhemorrhage.No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mild mucosal thickening in the paranasal sinuses and small maxillary mucous retention cysts are seen . Bone marrow signal and extracranial soft tissues are within normal limits.
1. Multiple T2/FLAIR hyperintense white matter lesions including few which are ovoid and perpendicular to the lateral ventricles, one lesion adjacent to the right temporal horn, as well as one involving the left lateral aspect of the middle cerebellar peduncle on the left adjacent to the trigeminal nerve root entry zone. Appearance and distribution of these lesions is suggestive although not diagnostic of demyelinating disease.2. 4 mm focus of susceptibility effect in the right posterior frontal lobe as well as multiple foci along the left pons and left middle cerebellar peduncle compatible with chronic microhemorrhages. Left middle cerebellar peduncle/left trigeminal nerve root entry zone lesion described in #1 is in itself suggestive of chronic demyelination; however the presence of chronic hemorrhage would be unusual. As such, superimposed chronic small vessel ischemic disease with chronic hemorrhage including the left pons should also be considered. 