28 years, Female, intermittent disconjugate gaze and fatigue. Evaluate for multiple sclerosis. Evaluate for aneurysms, family history of aneurysms. BRAIN: Unchanged subcentimeter nodular focus of mild T2/FLAIR hyperintensity in the left inferior parietal subcortical white matter. Few punctate additional foci of T2/FLAIR hyperintensity are again seen including the left frontal and bilateral parieto-occipital junction subcortical white matter and are also unchanged. There is no clear evidence of demyelinating disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Focus of susceptibility, subtle T2 hyperintensity, and faint enhancement in the right aspect of the pons likely represents an incidental capillary telangiectasia. There is otherwise no abnormal parenchymal or meningeal enhancement in the brain. No intracranial mass or mass-effect. No evidence of pituitary macroadenoma. Orbits are grossly unremarkable. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Unchanged heterogeneous signal involving the right aspect of the clivus which may be related to combination of asymmetric pneumatization and a small right sphenoid sinus mucus retention cyst; this finding is unchanged since 7/9/2015.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.
1. Unchanged few nonspecific foci of T2/FLAIR hyperintensity including a relatively more conspicuous left inferior parietal white matter lesion. These are nonspecific with differential including prior inflammation, demyelination, ischemia or other injury. No highly suggestive findings of demyelinating disease in the brain.2. No evidence of intracranial aneurysms.3. No evidence of pituitary macroadenoma. Note dedicated pituitary study is scheduled for a separate day.