Male, 21 years old, with Crohn's disease, on anti-TNF, with numbness and tingling of the upper and lower extremities. Concern for demyelinating disease. Brain:A thin rim of T2 hyperintensity is evident along the bilateral frontal horns. Posteriorly, the ventricular margins are spared. There may also be a single punctate focus of T2 hyperintensity within the white matter adjacent to the right frontal horn. Otherwise, no focal lesions are seen.No mass effect or parenchymal edema is seen. There are no abnormal extra-axial fluid collections. Slight asymmetry of lateral ventricular size is within the limits of normal variation. The ventricles are otherwise unremarkable. No pathologic intracranial enhancement is seen.Cervical spine:Alignment is anatomic. Vertebral body morphology is within normal limits. No evidence of marrow replacement or marrow edema is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No focal cord lesions or pathologic cord enhancement are detected.No significant degenerative disease is identified. The spinal canal and the neural foramina are patent.
1. A thin rim of signal abnormality is seen along the bilateral frontal horns, with perhaps a single punctate focus of T2 hyperintensity in the adjacent white matter on the right. The periventricular signal is somewhat unusual in a patient of this age (though it is seen commonly in older age groups), and it is conspicuous in that it affects the frontal regions preferentially. At this point, the findings are not sufficiently specific to make a diagnosis of demyelinating disease or any other process, and in fact, normal variation would still be in the differential. A follow-up exam may be considered to assess for any evolution of these findings.2. Examination of the cervical spine is within normal limits. No cord lesions are seen which would correlate with the patient's symptoms.