46 years Male (DOB:6/13/1969)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple periventricular and subcortical white matter lesions which are high signal on T2 and FLAIR and low signal on T1-weighted imaging. Lesions in the periventricular white matter are perpendicularly oriented to the lateral ventricles. No abnormal enhancing lesions are appreciated within the brain parenchyma. These have not changed substantially since the prior exam. There is an additional lesion present in the right posterior pons which was also present on the prior exam.Findings suggest cerebellar atrophy which was also present on the prior examNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The right internal carotid artery flow-void is very small along the ophthalmic segment on the current and on the prior exams. The right internal carotid arteries identified along the petrous segment and is diminutive. The right ophthalmic artery cannot be resolved on this exam. The right middle cerebral artery appears to originate from the basilar artery. Normal vascular flow voids are present in the distal left carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam there is no significant interval change. There is redemonstration of periventricular and subcortical as well as brainstem lesions which are compatible with demyelination.2.The right internal carotid artery is very small along the opthalmic segment. This could represent an acquired defect from prior carotid injury or developmental variant such as a hypoplastic opthalmic segment ICA with associated persistent fetal PCA redistribution of flow to the right middle cerebral artery via the vertebrobasilar system (Basilar origin of MCA). A CT angiogram of the brain may be of benefit to further evaluate this. A CT of the head with help confirm whether this is developmental (based on appearance of the petrous carotid canal) or acquired.