Wk 3, Case 1 - Review

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Report

Patient History
New paresthesias in the extremities

Findings
Innumerable predominantly subcentimeter ring and solid enhancing and non-enhnacing lesions throughout the subcortical and periventricular white matter of the bilateral cerebral hemispheres. There are non- enhancing lesions in the infratentorial space. There is slight enhancement of lesions predominantly in the periventricular white matter and centrum semiovale. Redemonstration of a background of extensive subcortical and periventricular white matter T2 FLAIR hyperintensities involving both cerebral hemispheres. There is a T2 hyperintense lesion within the central pons and possibly within the right brachium pontis.

No restricted diffusion to suggest territorial infarct. Left lamina papyracea fracture. Orbits are otherwise unremarkable. Mild mucosal thickening and partial opacification of multiple ethmoid air cells. Trace right mastoid effusion. Major intracranial vascular flow voids appear preserved.

Impressions
Innumerable predominantly subcentimeter ring and solid enhancing lesions throughout the subcortical and periventricular white matter of the bilateral cerebral hemispheres compatible with active demyelinating lesions of multiple sclerosis.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 3, Case 1 - Review