Diagnosis: Sarcoidosis of other sitesClinical question: Evaluate for progression of neurosarcoidosis lesion noted in prior MRI MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of volume loss associated with T2 and FLAIR signal hyperintensity involving the lateral aspect of the postcentral gyrus and precentral gyrus. This is stable since the prior exam.There is a focus of FLAIR and T2 signal hyperintensity along the medial aspect of the right temporal lobe measuring approximately 8 mm x 6 mm in axial dimensions.There is a small focus of the hypointensity on susceptibility weighted imaging within the right external capsule which is not readily identified on the T2, FLAIR or T1-weighted imaging (likely because it is too small).There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI thoracic spine:There is redemonstration of T2 signal hyperintense lesion within the spinal cord at the T2-3 level. This was also present in the 2012 exam and has not changed substantially. There is subtle contrast enhancement associated with this. There is redemonstration of mild narrowing of the spinal canal at the T2-3 level due to a disc bulge and some ligamentum flavum hypertrophy.There is redemonstration of a T2 hyperintense and T1 isointense lesion at the T4 vertebral body level is unchanged since previous exams. This lesion is also bright on inversion recovery and fat suppressed imaging.The patient is status post laminectomies in the lower cervical spine.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There are small pleural effusions present. These were also present on the prior exam.
1.There is a stable lesion within the spinal cord at the T2-3 level.2.Small foci of encephalomalacia are present in the right medial temporal lobe as well as the right pre and postcentral gyrus. These are stable since the prior exam.3.There is a microhemorrhage present in the right external capsule which was also present on prior exams and is stable.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No abnormal enhancing lesions are identified in the brain parenchyma at this time.6.Small pleural effusions are present. These have not changed substantially since the prior exam and may be slightly smaller.