Weakness after surgery, history of multiple sclerosis for 20 years. There are multiple supratentorial and infratentorial cerebral white matter T2 hyperintense lesions. Lesions in the bilateral superior frontal lobes appear to be more conspicuous. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.
Multiple supratentorial and infratentorial cerebral white matter T2 hyperintense lesions are compatible with demyelinating disease, perhaps with superimposed chronic small vessel ischemic disease. Lesions in the bilateral superior frontal lobes appear to be more conspicuous. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.