71-year-old female with weakness. Evaluate for acute MS exacerbation. Confluent and patchy T2/FLAIR hyperintensity within the subcortical and periventricular white matter, deep gray matter and brainstem have slightly progressed from prior study, most prominent within the centrum semiovale, left greater than right; these are oriented perpendicular to the white matter tracts suggestive of demyelinating disease. Additional ill-defined T2/FLAIR hyperintensity within the upper spinal cord is again noted and unchanged. Previous area of restricted diffusion within the right periventricular white matter signal are seen and has been replaced with focal encephalomalacia consistent with prior infarct. No new areas of restricted diffusion are identified. There is new susceptibility signal within the bilateral deep gray matter consistent with hemosiderin deposition and given lack of surrounding edema most likely represent chronic microhemorrhage; a more prominent area of susceptibility signal within the left posterior thalamus is likely due to previous hemorrhagic lesion. Additional foci of susceptibility signal within the cerebellum unchanged compatible chronic microhemorrhage. No acute hemorrhage is identified. No areas of abnormal enhancement are noted. Slight prominence of the ventricles and sulci are unchanged consistent with age-appropriate volume loss. No mass effect.The paranasal sinuses and mastoid air cells are clear. The imaged orbits are unremarkable.
1. Slightly progressing T2/FLAIR hyperintensity, especially within the left centrum semiovale, otherwise no significant interval change. The pattern of signal abnormality is perpendicular to the white matter tracts consistent with patient's known demyelinating disease. No evidence of active disease.2. Additional T2/FLAIR signal abnormalities noted within the upper spinal cord without significant interval change prior study. MRI of the cervical spine may be considered to evaluate the extent of spinal cord disease if clinically warranted.3. Focal encephalomalacia within the right periventricular white matter corresponds to prior area of restricted diffusion in this region compatible with chronic infarct. 4. New areas of hemosiderin deposition within the bilateral deep gray matter consistent with chronic hemorrhage including a a more prominent area within the left posterior thalamus which is likely due to previous hemorrhagic lesion. Unchanged foci of susceptibility signal within the cerebellum compatible with chronic microhemorrhage.