59 years, Female, frozen shoulders and asymmetric arm reflexes, now arms very weak. There are multiple scattered foci and confluent areas of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter. Many of these lesions demonstrate an ovoid morphology and periventricular distribution. Several infratentorial lesions are also noted including the pons, right cerebellar hemisphere, and right superior cerebellar peduncle There is moderate degree of global parenchymal volume loss including thinning of the corpus callosum. Many lesions with T1 hypointensity/black holes are also noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Major flow-voids are preserved. There is mild opacification of the left mastoid air cells as well as right posterior ethmoid air cells. Paranasal sinuses and mastoid air cells are otherwise clear. Bone marrow signal and extracranial soft tissues are unremarkable.
1. Multiple supra- and infratentorial T2/FLAIR hyperintense lesions with morphology and distribution consistent with chronic demyelinating disease. 2. Moderate degree of global parenchymal volume loss including of the corpus callosum. Multiple T1 hypointense lesions/black holes.If comparison study becomes available, an addendum can be issued to evaluate for new lesions. Postcontrast sequence may also be considered if there is suspicion for active demyelination.