 BRAIN: There is extensive T2 signal abnormality in the supratentorial brain predominantly (greater than 15 lesions with extensive confluent lesions), and scattered T2 lesions in the posterior fossa. Compared to the prior exam, there is mild to moderate interval increase of extensive confluent T2 hyperintense signal abnormality in the periventricular supratentorial brain. There are a few posterior fossa lesions redemonstrated and minimal in the bilateral cerebellar hemispheres. There is mild new ring enhancement of a right periventricular white matter lesion suggesting active demyelination. There is mild prominence of the ventricles representing global volume loss, unchanged.PITUITARY: There is a hypoenhancing lesion in the right pituitary gland measuring up to 7 mm without significant change. There is no mass effect on the optic apparatus or significant extension into the adjacent cavernous sinus. The infundibulum remains deviated to the left. There is increased asymmetric enhancement in the right cavernous sinus as compared to the left, also unchanged.
1.Mild to moderate interval worsening of confluent T2 signal abnormality in the supratentorial brain consistent with demyelination given history of multiple sclerosis. An old T2 hyperintense lesion in the right periventricular white matter shows new enhancement consistent with active demyelination.2.Stable 7-mm hypoenhancing right pituitary lesion perhaps representing a microadenoma.