Female, 73 years old, with dull bilateral eye pain and pressure, not typical for optic neuritis. Assess for retro-orbital mass or optic neuritis. Numerous scattered periventricular and subcortical white matter T2 hyperintensities are redemonstrated. Allowing for technical differences, there has been no significant interval change in the appearance of these lesions since the prior MRI.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. There is no evidence of any significant intracranial hemorrhage. No abnormal extra-axial fluid collections are detected. Ventricles are normal in size and morphology.Dedicated orbital imaging reveals no intraorbital mass, inflammation or pathologic enhancement. The globes are round and symmetric and demonstrate normal signal characteristics. The extraocular muscles are normal and symmetric in size. The optic nerves are likewise symmetric in size and morphology and free of pathologic signal abnormality and enhancement. The remainder the optic pathway is also unremarkable. Limited views of the pituitary are unremarkable and the suprasellar cistern is patent.Note is made of bilateral and symmetric infiltrative T2 hyperintensity spreading through the pterygoid muscle fibers of the masticator spaces. Corresponding infiltrative or intravascular hyperenhancement is also seen. No mass lesion or discrete fluid collection is seen. No adequate prior exams are available for comparison.
1.Stable examination of the brain. No acute intracranial abnormalities are detected.2.Unremarkable evaluation of the orbits.3.Bilateral and symmetric T2 hyperintensity is seen within the pterygoid musculature, along with infiltrative or perhaps intravascular enhancement. The significance of these findings is uncertain. The pterygoid muscles do contain a rich venous plexus which can manifest as T2 hyperintensity and enhancement on imaging. As such, this may simply represent a variation of normal. However, the possibility of an inflammatory process, perhaps a myositis, can also be considered. 