Painful eye movements and afferent pupillary defect of left eye. Evaluate for optic nerve abnormalities. Orbits: There is new diffuse high T2 signal and enhancement with mild swelling of the orbital segment of the left optic nerve. The left globe and ocular adnexa are otherwise unremarkable. There is no evidence of mass lesions. The right orbit is unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small area of subcortical high T2 signal in the right perirolandic region. There are also a few scattered foci of high T2 signal elsewhere in the cerebral white matter. There is no abnormal intracranial enhancement. 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 in the paranasal sinuses with interval decrease of the mucosal thickening in the sphenoid and posterior ethmoid sinuses.Cervical Spine: There is diminished cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small posterior disc-osteophyte complex at C5-6, without significant spinal canal or neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.
1. Newly apparent left optic neuritis. Differential considerations include an inflammatory process, such as IgG4-related disease or sarcoidosis, vasculitis, demyelinating process, neuromyelitis optica, or perhaps an infectious process, such as Lyme disease or a viral disease, but no evidence of compressive neuropathy.2. A few scattered cerebral white matter lesions are nonspecific, but may represent a demyelinating process, neuromyelitis optica, vasculitis, or infectious/inflammatory process, perhaps related to the optic neuritis, but no evidence of acute infarct. 3. No evidence of cervical spinal cord lesions.4. Postoperative findings related to sinus surgery with interval improvement in the previously demonstrated paranasal sinus inflammatory process.