 Again seen are numerous supratentorial, predominantly periventricular, T2/FLAIR hyperintense lesions with morphology and distribution consistent with known demyelinating disease. Several infratentorial lesions including the middle cerebellar peduncles and right cerebellar hemisphere are also again seen. Cervicomedullary junction lesion is also unchanged. No new lesions are appreciated. No abnormal enhancement. There is moderate to severe burden of T1 hypointense lesions similar to prior. There is also mild parenchymal volume loss including thinning of the corpus callosum. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Calvarium and extracranial soft tissues in the head are otherwise grossly unremarkable.Partially imaged in the neck is what likely represents focal enlargement of an enhancing vascular structure immediately adjacent to or involving the right jugular vein (best seen on coronal series 1303, image 95). This lesion measures up to 2.2 cm in diameter and has been present on multiple prior studies.
1. Compared to 1/24/2015, there is no evidence of progression of demyelinating disease in the brain.2. Focal enlargement of a vascular structure in the right neck. Unclear if this may represent the jugular vein itself or possibly aneurysm of an arterial structure just next to the jugular vein. Would consider dedicated CTA neck further evaluation. This lesion however has been present on multiple prior studies. 