 ORBITS: The globes are symmetric and normal in appearance. There is bilateral proptosis, left greater than right, which is without significant interval change. There is prominent intraorbital fat bilaterally, similar to prior exam. The right optic nerve sheath is slightly more full compared to the left on the order of 1 mm or less, and without significant change. The optic nerves are not thickened and appear symmetric bilaterally with normal signal intensity. The extraocular muscles are within normal limits of size and appear symmetric bilaterally, and unchanged from prior exam. The lacrimal glands enhance symmetrically and are not enlarged. There is a partial empty sella with a thin and somewhat flattened pituitary gland which enhances homogeneously. There is a midline pituitary stalk. The cavernous sinuses enhance symmetrically and show no evidence of mass. The superior ophthalmic vein is not enlarged.BRAIN: There is no suspicious enhancement, acute infarct, mass, or cerebral edema. There are scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.
1.Stable exam of the orbits with bilateral proptosis, left greater than right. No intraorbital mass, extraocular muscle thickening or suspicious enhancement.2.Scattered periventricular and subcortical white matter T2 hyperintensities are nonspecific. The differential diagnosis is wide and includes vascular related etiologies, demyelination, HIV-related etiologies among others.