I'm not looking for a diagnosis, just possible explanations. Any help would be appreciated!
- Nonspecific T2 signal abnormalities in the periventricular white matter, none of which have imaging features highly specific for this condition. No juxtacortical lesions, no infratentorial lesions and no enhancing lesions. Early arterial sclerosis is also possible for the imaging features but would not account for the clinical findings.
- No findings to specifically account for the symptoms.
HISTORY: Change in mental status, paresthesias, ataxia and tinnitus, suspected multiple sclerosis
TECHNIQUE: An MRI of the brain was performed on a 1.5T magnet.
CONTRAST: Images obtained before and after 10cc of ProHance
COMPARISON: No prior studies available for comparison.
The gaddinium-enhanced images show no foci of abnormal enhancement within the brain parenchyma.
The FLAIR images show abnormal increased signal on the undersurface of the corpus callosum, parallel to the body. In addition, there are several small faint periventricular lesions. These include a 9 x 3 mm streaky focus in the left vertebral white matter series 8 image 12 and a few faint subcentimeter foci of abnormal T2 prolongation seen within the right and left corona radiate on FLAIR images (see Series 10, images 24 and 15). These findings are equivocal for changes of chronic small vessel ischemic change versus early multiple sclerosis. Subcallosal striations perpendicular to the corpus callosum are somewhat more specific for multiple sclerosis and other causes of white matter signal abnormality but in this case it is not clear if images demonstrate true striation or normal variants of gray matter bridging. The linear focus along the undersurface of the corpus callosum is also a nonspecific finding but more typical of ependymitis granularis which is a normal variant of aging.
There are no lesions in the infratentorial brain parenchyma, and no lesions that are juxtacortical. None show restricted effusion.
High-resolution images of the brainstem were additionally obtained to specifically evaluate clinical symptoms of tinnitus. These images showing normal appearance to both the right and left vestibulocochlear nerve complexes with no evidence of a potential vestibular schwannoma.
The brain is otherwise normal in appearance. There is no evidence of acute or subacute ischemia, hydrocephalus, mass lesion or fluid collection.
The mastoid air cells and middle ear cavities are clear. Tiny retention cyst right maxillary sinus. Remaining paranasal sinuses are clear. The globes and orbits are normal.