Weakness, visual disturbances, evaluate for multiple sclerosis flare. Also history of pseudotumor. Again seen are multiple T2 hyperintense lesions in the supratentorial and infratentorial white matter consistent with known demyelinating disease. Compared to 3/31/2011, there is a new focus of flair hyperintensity involving the left posterior frontal periventricular white matter involving the left precentral gyrus, axial flair image 23/34. There is also a small T2/flair hyperintense focus lateral to the left frontal horn, axial T2 image 18 of 30, which is also new. There is a focus of T2/flair hyperintensity involving the subcortical right frontal white matter which is decreased in the interval. No abnormal enhancement. No restricted diffusion. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is advanced for age. Volume loss also is noted involving the corpus callosum. Multiple lesions with T1 hypointensity are also again seen.Dedicated orbital sequences were not obtained, however, no obvious abnormality is appreciated. Empty sella is again noted. There is mild mucosal thickening involving the paranasal sinuses. There is moderate opacification of the right mastoid air cells.
1. Chronic demyelinating disease involving the supratentorial and infratentorial white matter. There is evidence of progression with at least two new lesions in the left frontal white matter as detailed above compared to 3/31/2011. No abnormal enhancement to suggest active demyelination. 2. Partially empty sella which is a normal variant but can be seen with intracranial hypertension in the appropriate clinical setting.