Female, 39 years old, with a right cranial nerve 6 palsy, assess for brainstem lesion, please compare to MRI up loaded on PACS, please do Dr. Javed MS protocol. Multiple round and oval T2 hyperintense lesions are demonstrated within the bilateral cerebral white matter. Some of these contact the ventricular surface and are oriented radially with respect to the ventricles. Most of these lesions have not significantly change from the prior examination. One lesion in the right corona radiata has however notably decreased in size. This lesion enhanced vigorously on the prior examination and does so only minimally on today's study. Several additional lesions showed a faint blush of enhancement on the prior examination which has resolved.Since the prior examination, a new 5-mm focus of T2 hyperintensity has developed within the right aspect of the midbrain, lateral to the red nucleus and just posterior to the substantia nigra (image 13 series 501). This lesion does enhance on postcontrast imaging. Within the pons, there is a punctate (2-mm) focus of T2 hyperintensity just to the right of midline which is also probably new (image 11 of series 501). No clear evidence of enhancement is seen. There may also be a new 4-mm focus of T2 hyperintensity within the right aspect of the medulla (image 12 series 1601).No evidence of significant mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid is seen. The lateral ventricles are slightly asymmetric in size but this is likely within the limits of normal variation.The cisternal portions of the visualized cranial nerves are within normal limits. The pineal gland is mildly prominent which may represent the presence of small internal cysts, a stable finding.
1. Multiple supratentorial white matter lesions are seen compatible with demyelinating disease. Most of these lesions are stable in size with the exception of one in the right corona radiata which has decreased in both size and enhancement from the prior exam.2. Several new lesions are identified within the brainstem including one at the right aspect of the midbrain, another just to the right of midline in the pons, and a third in the right aspect of the medulla. The lesion in the pons could potentially be affecting the right sixth cranial nerve as it passes from its nucleus anteriorly to its root exit point at the ventral pons.