 There are moderate confluent and punctate cerebral supratentorial and infratentorial white matter non-enhancing T2/FLAIR hyperintense lesions. Some of these lesions are low on T1 signal. There is moderate volume loss including the corpus callosum. There is questionable T2 hyperintensity of the right optic nerve, which appears to be present on the prior study, but not optimally evaluated on brain MRI. No enhancing lesion to suggest active demyelination. Subtle new increase in vascularity of the right cerebral hemisphere, which may be related to hyperemia from recent seizure activity. There is unchanged small enhancing lesion measuring 7-8mm within the inferior right fourth ventricle. There is no evidence of intracranial hemorrhage. No diffusion-weighted abnormality is identified. Partially empty sella. Flow voids are present within the major vessels indicating patency. There is no midline shift or herniation. There are small left posterior ethmoid and left maxillary sinus retention cyst. The skull and extracranial soft tissues are otherwise unremarkable.
1. No appreciable change in moderate confluent and punctate supratentorial and infratentorial white matter non-enhancing T2 hyperintense lesions which are compatible with known multiple sclerosis. No new lesions or enhancement to suggest active demyelination.2. Stable subcentimeter enhancing lesion in the inferior right fourth ventricle, which may represent asymmetric prominence of the normal choroid plexus versus neoplasm such as a small choroid plexus papilloma. Suggest continued attention on follow-up. Comparison with remote prior studies would be helpful if available.3. Asymmetrically increased vascular enhancement involving the right cerebral hemisphere, which may be related to hyperemia from recent seizure activity. 