Unspecified nystagmus [H55.00] / Unsteadiness on feet [R26.81], Reason for Study: ^Reason: Evaluate for brainstem lesion History: Horizontal and vertical nystagmus, episodes of gait instability Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are, however, multifocal high signal intensity lesions on bilateral periventricular white matter, centrum semiovale, bilateral trigone area (right worse than left) and right midbrain. These lesions appear to be a bit perpendicular to the axis of ventricular system suggesting possible demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous major arch vessels without evidence of luminal stenosis. In particular, the right extracranial ICA is located medially and likely to be retropharyngeal course. Bilateral carotid bifurcation appear to be normal without evidence of luminal stenosis.Vertebrobasilar system appears to be normal without showing any evidence of luminal stenosis.
1. Multifocal scattered high signal intensity lesions on white matter on FLAIR images. Diagnostic possibility includes demyelinating disease such as multiple sclerosis. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal brain MRA.3. Tortuous course of craniocervical arterial system without evidence of luminal stenosis or irregularity. 