Multiple sclerosis. There are numerous supratentorial and to a lesser extent infratentorial white T2 hyperintense matter lesions, which appear to be unchanged. The majority of the lesions are T1 hypointense, but there is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are mild secretions or mucosal thickening in the right sphenoid sinus.
The demyelinating lesions are grossly unchanged and there is no evidence of associated acute inflammation.