Clinical question: Rule out PML. Signs and symptoms: New onset of bilateral upper extremity weakness. Nonenhanced brain MRI:No acute intracranial process and no evidence of acute ischemic stroke.Examination to demonstrate multiple small foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres consistent with patient's diagnosis of demyelinating disease. Compared to prior exam however there are a few small new lesions in the subcortical white matter of bilateral cerebral hemispheres. There are two small lesions in the right frontal on axial flair series 701 image 20 and two small new lesion in the left anterior temporal on flair T2 3701 image was 9 and 10 Surgicel of mild progression of disease since prior exam from 2013.Cortical sulci and the lateral ventricles appear slightly prominent for patient's stated age however without change since prior exam.The signal right major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and calvarium.
1.No acute intracranial process.2.Mild interval progression of demyelinating disease evident by at least four small new lesions in the subcortical white matter of right frontal and left anterior temporal lobes since prior exam from 2013.