Clinical question: Assess midbrain left paramedian stroke vs demyelinationSigns and Symptoms: Outside scan from last spring shows what appears to a small right paramedian stroke Diplopia and eye pain. Pre ans post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates no evidence of chronic ischemic stroke as is clinically questioned.The anatomical morphology and signal intensity of brain parenchyma remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.The signal intensity in the intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable calvarium and soft tissues of the scalp without abnormal enhancement.Unremarkable paranasal sinuses and well pneumatized bilateral mastoid air cells and middle ear cavities.
Negative pre-and post enhanced brain MRI.