Multiple sclerosis. There is extensive, mainly confluent and periventricular, bilateral cerebral white matter T2 hyperintensity with areas of associated T1 hypointensity. There are also a small areas of T2 hyperintensity in the medial left middle cerebellar peduncle and medial left cerebellar hemisphere white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Extensive white matter disease related to multiple sclerosis with associated cerebral volume loss, but no evidence of acute inflammatory lesions.