 The ventricles and sulci are within normal limits. The basal cisterns are patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, corpus callosum, cerebellum and brainstem, consistent with history of multiple sclerosis. No enhancing lesions. A small focus of susceptibility artifact in the periventricular right parietal lobe is consistent with hemosiderin deposition. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is extensive mucosal thickening involving all the sinuses with multiple areas of low T2 signal, consistent with fungal sinusitis. There are erosive changes with bulging of the contents of the left ethmoid sinus into the subcutaneous tissue along the left nasolabial fold/cheek (image 7, series 1001). There is nasal septum deviation towards the right.MRI of the orbits demonstrates no mass lesion. Subtle enhancement along the left optic nerve is suspected. Evaluation is somewhat limited by motion artifact, but no definite signal abnormality is identified. The retroorbital fat is preserved. The extraocular muscles are intact.
1. Multiple foci of abnormal T2 signal within the supra- and infratentorial white matter, consistent with history of multiple sclerosis. 2. Subtle enhancement of the left optic nerve is suspected. Motion artifact somewhat limits evaluation, but no other definite signal abnormality is identified.2. Extensive chronic fungal pansinusitis, with focal bulge of sinus contents into the subcutaneous tissue along the left nasolabial fold/cheek.  