Progressive spasticity. Assess for progression of white-matter disease. The T2/FLAIR hyperintense lesions predominantly involving the putamina, the caudate nuclei as well as the central pons and, to a lesser extent, the thalami have not changed in distribution since the previous examination. The lesions are more conspicuous but this may relate to technique (today's examination was obtained on 3.0 Tesla system compared to 1.5 Tesla for the previous examination). A few similar lesions are present in the cerebral white-matter, of which the ones involving the inferior aspect of the left temporal lobe were not present previously. There is no associated diffusion restriction or contrast enhancement. Brain volume loss remains mild. There is no mass effect or midline shift. There is no abnormal leptomeningeal or nerve root contrast enhancement. Major intracranial vascular flow voids are preserved, reflecting gross patency. The intradural left vertebral artery shows persistent focal mural based irregularity, which may represent an atherosclerotic plaque but there is no significant stenosis.There is no destructive skull lesion. There is no gross orbital abnormality. There is mild maxillary, ethmoid and sphenoid sinus mucosal thickening that is worse on the right.
The distribution of the nonenhancing T2-hyperintense lesions in the putamina, caudate nuclei, thalami, pons as well as cerebral white-matter does not appear significantly changed, with very minimal progression. Increased conspicuity of lesions likely in part relates to differences in technique.