Female, 22 years old, with trigeminal neuralgia and atypical facial pain, and nonspecific T2 lesions in the right periventricular area. Brain:A scattering of small round and curvilinear T2 hyperintense lesions is again seen in the periventricular regions, more so on the right than on the left. The overall distribution of these lesions is unchanged relative to the prior examination. While some of these lesions appear more conspicuous on today's examination, this can reflect the differences in imaging at 3T versus 1.5T. One lesion in the right corona radiata demonstrates punctate associated enhancement. Several lesions in the bilateral periventricular regions show punctate associated susceptibility.No restricted diffusion is seen. There is no evidence of parenchymal edema or mass effect. Other than that mentioned above, no additional pathologic parenchymal or extra-axial enhancement is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is normal in size.C-spine:Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement, marrow edema or pathologic marrow enhancement is seen.The cervical spinal cord shows normal signal intensity and morphology throughout. No pathologic intramedullary or leptomeningeal enhancement is seen.There may be a very small central annular fissure at C5-6. The intervertebral discs are otherwise within normal limits. No significant spinal canal or neuroforaminal stenosis is seen.
1.Multiple small T2 hyperintense lesions are again seen in the periventricular white matter. No definite interval change is seen, though some of these lesions appear more conspicuous than on the prior examination. This difference could, however, simply represent the effect of imaging at 3T. One lesion, in the right corona radiata, demonstrates punctate associated enhancement which may indicate an active process. Several lesions show evidence of associated microhemorrhage. Findings are nonspecific and the differential diagnosis would include a vascular etiology, including both vasculitis and ischemia, as well as other inflammatory conditions and demyelination.2.The cervical spine is free of significant abnormalities. In particular, the spinal cord is unremarkable.