Diagnosis: Optic neuritis, unspecifiedOptic neuritis, unspecifiedClinical question: Optic neuritis protocolSigns and Symptoms: optic neuritis MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular white matter lesions many of which are perpendicularly oriented to the lateral ventricles. One in the right centrum semiovale enhances following contrast administration and measures approximately 26 x 15 mm coronal dimensions. There are several additional enhancing lesions present adjacent to the temporal horn of the left lateral ventricle within the white matter within the medial left temporal lobe. There is a ring-enhancing lesion present adjacent to the occipital horn of the right lateral ventricle. There is a couple small enhancing lesions present in the periventricular white matter adjacent to the trigones of the lateral ventricles bilaterally.Additional FLAIR hyperintense lesion is present in the right brainstem at the level of the pons and in the right cerebellar hemisphere inferiorly as well as the right cerebellum superiorly. These do not enhance following gadolinium administration.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There are multiple lesions present within the brain parenchyma especially in the periventricular white matter but also present in the cerebellum and pons which are nonspecific but can be explained on the basis of demyelination other diagnostic considerations may include vasculitis and sarcoid.2.There are multiple enhancing lesions present in the periventricular white matter as well as in the left medial temporal lobe white matter the largest one being in the right centrum semiovale. One consideration is that these represent acute plaque formation if the patient has multiple sclerosis though they could also be a result of a granulomatous disorder as well. They are nonspecific3.No spinal cord lesion is identified and there is no convincing evidence for optic neuritis on the basis of MRI findings alone.