CLINICAL INDICATION: 33-year old with dizziness and giddiness.
COMPARISON: No priors
TECHNIQUE: Multi-planar T1, T2, FLAIR, and diffusion-weighted sequences obtained through the brain before and after administration of 15 ml intravenous Magnevist gadolinium contrast. Dedicated multi-planar sequences were obtained through the internal auditory canals.
FINDINGS: There is 0.8 cm focus of increased T2 and FLAIR signal I the right parietoccipital white matter just above the lateral venticle occipital horn. This does not demonstrate any significant restricted diffusion and so appears chronic. There is no enhanement.
A few additional 0.3 to 0.4 cm foci of abnormal white matter signal are seen in the left frontal deep and periventricular white matter. Corpus callosum and pericallosal white matter relatively spared.
Internal auditory canals and their contents appear normal. No abnormal enhancement in the brain or internal auditory canals after contrast.
1. Several foci of abnormal white matter signal in the left frontal and right occipital white matter. This is more than expected given the patient’s young age and so differential includes small vessel disease, migrainous angiopathy, or a typical appearance of demyelinating disorder.
Second MRI taken on September 26, 2008
MRI BRAIN WITHOUT AND WITH CONTRAST.
HISTORY: Demyelinating disorder.
TECHNIQUE: Sagittal T1 and FLAIR, and axial diffusion, T2, FLAIR, and images; 20 ml intravenous Magnivest given.
FINDINGS: No significant interval change. Again seen are linear T2/FLAIR weighted hyperintense lesion present in the cerebral hemispheres. Approximately seven lesions are in the right parietal lobe. A single tiny lesion in the subcortical white matter of the anterior right frontal lobe near the vertex. Two small linear lesions in the left corona radiata. A single small lesion in the subcortical white matter of the left parietal lobe. The largest lesion is in the right parietal lobe and remains stable at 10 mm in length. The largest lesion in the right parietal lobe and the lesion in the posterior left corona radiata again demonstrate diffusion weighted hyperintensity. The largest lesion in the right parietal lobe demonstrates mild T1 weighted hypointensity. No enhancing lesion is evident. No brainstem lesion is evident.
No enhancing intracranial mass. No definite intracranial hemorrhage. No mass effect or medline shift. Ventricles are normal in size. Gray-white matter differentiation is intact. Orbits are intact. Flow voids aerated. Mild mucosal build thickening in the frontal, ethmoid, and maxillary sinuses.
Motion is present.
Stable hyperintense lesion, as described above. They are suggestive for demylinating plaques related to the multiple sclerosis. Please clinically correlate.
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