Reason: Significant pain with extra ocular movement, evaluate for optic neuritis, MS or other inflammatory conditions. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. There are several punctate foci of increased T2/FLAIR signal within the subcortical and periventricular white matter with at least one punctate focus of increased T2/FLAIR signal within the right posterior pericallosal region (series 3, image 71). No abnormal enhancement is identified within the cerebral or cerebellar hemispheres. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is nonspecific flattening of the pituitary consistent with a partially empty sella.Limited images of the orbits demonstrate suggestion of increased enhancement of the right greater than left optic nerves, though this is inadequately evaluated in the absence of dedicated orbital sequences. No gross intraorbital masses are identified. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Please note that dedicated orbital MRI images were not obtained which significantly limits evaluation of the orbits including evaluation for optic neuritis. Within this limitation, there is suggestion of increased enhancement involving the optic nerves (right greater than left) which can be seen with optic neuritis but which is incompletely assessed. No intraorbital masses are identified.2.Minimal scattered foci of increased T2/FLAIR signal which are nonspecific. There is, however, a single punctate pericallosal focus of signal abnormality suggesting the possibility of demyelinating disease. Brain parenchyma otherwise appears unremarkable.3.Suggest dedicated orbital MRI. Also suggest correlation with CSF analysis if there is clinical suspicion for demyelinating disease.Findings were relayed to the clinical service via stat consult system by radiology on-call resident at 9:07 PM on 8/5/2016.