Internuclear ophthalmoplegia. There are numerous, greater than 10, T2 hyperintense white matter and thalamic lesions, including a lesion in the posterior midbrain, around the midline, and left paramedial posterior pons. Many of the lesions display low T1 signal, but no associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is flattening of the pituitary gland. 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.
1. Findings compatible with demyelinating lesions suggestive of multiple sclerosis with involvement of the medial longitudinal fasciculus, which could account for the internuclear ophthalmoplegia.2. Nonspecific flattening of the pituitary gland, which can be a manifestation of pseudotumor cerebri. 