Diplopia. Right ocular pain. History of sarcoidosis, Hashimoto's thyroiditis, discoid lupus, and hypersensitivity pneumonitis. BRAIN:Few nonspecific punctate subcortical and confluent periventricular T2 FLAIR-hyperintense foci are present in both cerebral hemispheres. These are not significant change since the previous examination. A similar lesion involving the dorsal pons just medial to the left middle cerebellar peduncle was present previously. An additional lesion involving the medial aspect of the right middle cerebellar peduncle anterior to the right dentate nucleus was not present previously. This area is obscured by pulsation artifact related to the sigmoid sinuses on the post contrast imaging.There is increased T2 FLAIR signal along the callososeptal interface without separate, intrinsic callosal lesions. The corpus callosum is preserved in volume. There is no acute infarct. There is a linear area of T1/T2 FLAIR hyperintense signal along the undersurface of the left tentorium cerebelli (measures 5 mm x 2 mm on axial image #35 of series #801) which is unchanged since the previous examination and may represent a small meningioma that is calcified. Otherwise, there is no space-occupying or contrast-enhancing brain lesion. The pituitary gland is also within expected. The ventricles and CSF-containing spaces are normal in size. There is mild mucosal thickening involving the paranasal sinuses which is nonspecific. The mastoid air cells are clear.ORBITS:There is no orbital abnormality. Specifically, the optic nerves are symmetric in size and signal characteristics. There is no abnormal orbital contrast enhancement. Slightly prominent contrast enhancement around the optic nerve sheath complex in the posterior aspect of the orbits is unchanged. The optic chiasm is also unremarkable and there is no suprasellar mass.
1.Multiple cerebral and to a lesser extent cerebellar/brainstem white-matter lesions are nonspecific. One of the lesions which involves the right middle cerebellar peduncle is new since the September 2015 examination. However, enhancement characteristics of the lesion cannot be assessed given pulsation artifact as described above. The other lesions are not significant changed. Similarly, increased signal along the callososeptal interface without separate, intrinsic callosal lesions or volume loss is nonspecific.2.Orbital imaging shows no abnormality.3.Tiny linear area of abnormal signal along the the left tentorium cerebelli is unchanged since the previous examination and may represent a small meningioma that is calcified.