Female, 33 years old, with burning of both hands and feet and right face numbness. Concern for MS. Follow-up study. Brain:Numerous scattered small foci of T2 hyperintensity are demonstrated within the cerebral hemispheres bilaterally. Lesions are seen in the periventricular and peripheral subcortical regions. Of note, lesions are also present in the high paramedian frontal lobes and within the anterior temporal poles. The corpus callosum is only minimally affected, and the brainstem and cerebellum are spared. No pathologic enhancement is seen. On comparison with the prior examination, no significant change in lesion size or number is demonstrated. None of the lesions causes any significant edema or mass effect. No abnormal fluid collections are seen. The ventricles are normal in size and morphology.Cervical spine:The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No pathologic enhancement is suspected.Reversal of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow signal abnormality or enhancement is seen. The intervertebral discs are preserved. No compromise of the spinal canal or neural foramina is seen.
Numerous scattered small white matter lesions are demonstrated supratentorially, none of which elicits any associated edema or pathologic enhancement. On comparison with the prior MRI examination, there has been no clear interval change in lesion size or number. No spinal cord lesions are demonstrated in the cervical region.Demyelinating disease would certainly be in the differential diagnosis for findings such as these. However, given the distribution of the lesions, the possibility of a vascular process such as CADASIL or some other form of vasculitis should also be considered.