Reason: Workup for nonspecific symptoms concerning for MS History: paresthesias, weakness, fatigue. There is a small, solitary wedge-shaped T2 and FLAIR hyperintense area immediately beneath the cortex of the posterior superior right temporal lobe without associated mass effect, enhancement, susceptibility or diffusion restriction. No additional abnormal T2 signal, specifically no pericallosal lesions.There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Small very peripheral right temporal T2 hyperintense region is nonspecific. The location is not typical for MS or other common demyelinating processes. This could possibly represent a prominent, although atypical, perivascular space. Otherwise, the differential is broad, including atypical demyelinating disease, sequela of prior trauma, and vasculitis among other etiologies.