Male 62 years old with left face and hand numbness, evaluate for interval progression of white matter disease New area of prominent increased left posterolateral medullary FLAIR/T2 signal with associated mild parenchymal expansion. The lesion does not show restricted diffusion. Prior exam demonstrates patchy increased T2 signal just caudal to this lesion, which may represent artifact. Additional scattered bilateral predominantly periventricular T2/FLAIR hyperintense white matter lesions with corresponding T1 hypointensity appear stable from prior exam. Possibility of underlying minimal chronic small vessel disease is not excluded. Diffuse sulcal and ventricular prominence more than expected for patient's age.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild paranasal sinus mucosal thickening in the maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.
1) New left posterolateral medullary T2/FLAIR hyperintense lesion with associated mild expansion, most likely representing a new and likely active demyelinating plaque, which may involve the left spinal trigeminal tract given patient's reported symptoms. Evaluation limited due to lack of contrast.2) Chronic bilateral periventricular predominant white matter lesions consistent with known demyelinating disease, which appear stable from prior exam. Overall, mild T1 and T2 burden of disease.