Complex multisystem autoimmune disorder with headache and back pain. Brain: There are new subcentimeter enhancing lesions in the left middle and superior frontal gyri. However, there is considerable interval regression of the right cerebellar and left posterior parietal lobe lesions. Otherwise, there is no significant interval change in the non-enhancing patchy white matter T2 hyperintensity in the left perirolandic and adjacent periventricular white matter and in the right superior frontal gyrus. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings related to left frontal biopsy. The orbits are grossly unremarkable. There is persistent diffuse paranasal sinus mucosal thickening and secretions.Spine: Since September 2015, there has been interval increased swelling in the spinal cord at the C6 through T3 levels with associated T2 hyperintensity and marked enhancement. The rest of the spinal cord is unremarkable. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.
1. Interval development of enhancing lesions in the left frontal lobe, but regression of the right cerebellar and left posterior parietal lobe lesions, and unchanged lesions in the right superior frontal gyrus and left perirolandic and adjacent periventricular white matter.2. Since September 2015, the inflammatory lesion in the spinal cord at the C6 through T3 levels has worsened. 3. Diffuse inflammatory changes in the paranasal sinuses may represent acute sinusitis, either infectious or perhaps related to the autoimmune disorder.