Chronic headache with photophobia and rash. There are numerous, greater than 10, punctate cerebral white matter T2 hyperintense lesions without abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There may be enhancement of the canalicular portion of the left optic nerve versus artifact. There are no meningeal lesions. 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. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst and fluid.
1. Multiple scattered punctate cerebral white matter lesions are nonspecific, but may represent demyelinating or chronic vasculitic lesions for example. 2. Possible enhancement of the canalicular portion of the left optic nerve versus artifact, although the sequences are not optimized for assessment of this anatomy and a dedicated orbit MRI may be useful. If it is an actual abnormality, this could also be related to a demyelinating or vasculitic process.3. Findings suggestive of acute left maxillary sinusitis.