Wk 1, Case 1 - Review

Patient History

Papilledema

Findings
Pre and post contrast MR was performed of the brain and the orbits.

Brain: Sagittal T1-weighted images demonstrate corpus callosum to be intact. No evidence of Chiari malformation. No abnormal pineal region masses. Mild flattening of pituitary gland. Diffusion imaging demonstrates no evidence of recent infarct. Contrast-enhanced T1-weighted images demonstrates multiple focal enhancing intraaxial lesions seen throughout the brain parenchyma predominantly involving the juxtacortical, centrum semiovale, periventricular white matter and periatrial regions. The most dominant area of enhancement is a 1.6cm x 1.1cm ring-enhancing lesion involving the left centrum semiovale. These areas of enhancement are associated with multiple ill-defined areas of increased FLAIR and T2 signal and most consistent with active multiple sclerosis.

Orbits: There is diffuse long segment enhancement of the left retrobulbar optic nerve which extends posterior to the orbital apex. The enhancement involving the optic nerve is predominately involving the dural sheath. This is somewhat atypical for optic neuritis as the enhancement is typically involving the optic nerve. However, it is possible this could be due to acute and extensive nature of this disease. No definite evidence of enhancement is identified involving the right retrobulbar optic nerve. No abnormal intraocular enhancing lesions are identified.

No abnormal sellar or juxtasellar enhancing lesions are seen. No evidence of compressive lesions are identified involving the optic chiasm. No abnormal lesions are identified involving the anterior skull base or olfactory sulcus. The bilateral gyrus rectus are normal. No evidence of aggressive skull base lesions are seen. No abnormal enhancing lesions are identified in the region of the perimesencephalic cistern. The region of Meckel's cave is symmetric.

Conclusions
1. Multiple intraparenchymal enhancing lesions associated with numerous white matter abnormalities and enhancement of the retrobulbar left optic nerve. The findings are consistent with acute multiple sclerosis and left optic neuritis. The peripheral enhancement of the left optic nerve is somewhat atypical for acute optic neuritis. However, this could be due to the acute nature of the disease. These findings should be correlated with the clinical symptoms and other diagnostic features of multiple sclerosis.

2. No evidence of ventriculomegaly.