Clinical question: Rule out demyelinating pathology. Signs and symptoms: Numbness and tingling of the arms and legs, on and off for years. Pre and post enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates several tiny foci of FLAIR hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres and a single similar lesion in the right external capsule which are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. Findings are nonspecific and possibilities of mild chronic small vessel ischemic strokes or demyelinating disease should be considered. The lesion do not present typical morphology for demyelinating disease and are not identified in the corpus callosum, pons, midbrain or the cerebellar peduncles.The cerebral cortex, cortical sulci, ventricular system and CSF spaces are within normal for patient's stated age.There is no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat postcontrast enhanced series.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.No diffusion-weighted abnormalities.2.Few nonspecific punctate foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter as detailed above.3.Unremarkable pre and post enhanced brain MRI otherwise.