MRI - 4/22/2004
Clinical History: Facial numbness

Findings: Patient has soft tissue inflamatory change in the maxillary sinus air cells bilaterally compatible with chronic sinusitis. Globes and orbits are unremarkable in appearance. Mastoid sinus air cells are clear.

Ventricles are symetric and have normal size and shape. Cisteerns are patent.

The corpus callosum is complete. The pituitary infundibulum is midline. The pituitary gland is normal in size and shape. Visualized portions of the brain stem and posterior fossa are unremarkable. The cerebellar tonsils end at a normal level with respect to the foramen magnum.

Patient has innumerable areas of increased FLAIR and T2 signal in the periventricular white matter of both hemispheres. There are also areas of gliosis which are seen as low signal on T1 weighted images. Areas of gliosis are present adjacent to the frontal horn right lateral ventricle. A few of the white matter lesions enhance. The enhancing lesions are located high in the centrum semiovally of both hemispheres. Signal abnormality is also present in the corpus callosum. There is no evidence of edema or mass effect. Findings are compatible with a demyelination, probably multiple sclerosis in a patient of this age. Please note, post viral toxic demylenation can have similar appearance. Multiple sclerosis is more common.

Impression: Brain findings compatible with multiple sclerosis. Both acute and chronic components are present.
Kari Dittrich, MD 4-22-04

MRI - 4/22/2005
Findings: Comparison is made to an MRI brain done April 22, 2004

The patient has soft tissue inflammatory change in the maxillary sinus air cells bilaterally. There is a 1.5 cm convex soft tissue density on the floor of the left maxillary sinus probably representing a mucous retention cyst or polyp. Globes and orbits are unremarkable in appearance. Optic nerves are symmetric. Extraoccular muscles are symmetric. Mastoid sinus air cells are clear bilaterally.

The pituitary infundibulum and the pituitary gland are normal size and shape. The corpus callosum contains numerous areas of signal abnormality. There is a mild cortical atrophy. The brain stem and posterior fossa are normally configured. Cerebellar tonsils end at the normal level within the magnum.

Ventricles are symmetric and of normal size and shape. Cisterns are patent. The sulcal and gyral pattern is normal.

There are innumerable areas of increased FLAIR and T2 signal on the white matter of both hemispheres compatible with MS plaques. The plaque load has increased since the reference study. There is a 1 cm area of gliosis in the right frontal lobe adjacent to the frontal horn of the right lateral ventricle. This was seen previously. There is a 1.2 cm enhancing lesion in the left occipital lobe just posterior to the occipital horn left lateral ventricle. This lesion was present previously but it has increased in size and is now enhancing. This is probably an active MS plaque. Again seen are innumerable areas of increased FLAIR and T2 signal in the white matter of both hemispheres. Once again the plaque load has increased since the reference exam. There is no evidence of mass or mass effect.

Impression: Multiple areas of increased FLAIR and T2 signal in the white matter of both hemispheres. Also within the corpus callosum findings compatible with the diagnosis of multiple sclerosis. The plaque load has increased in the interval between examinations. At this time there is a 1.2 cm enhancing lesion in the left occipital horn of the left lateral ventricle. There are also numerous small areas of gliosis again noted.
Kari Dittrich, MD 4-22-05

Date of Examination2/15/2006
Clinical HistoryPatient with Multiple Sclerosis
Technique MR 104-Brain with and without contrast. MRI of the brain was performed using the following imaging sequences: sagittal T1, axial T1, axial FSE T2, axial FLAIR, coronal FSE T2, Axial T1 post gadolinium, coronal T1 fat saturation post gadolinium, sagittal T1 post gadolinium (if needed for tumor), and diffusion wheighted images; plus sagittal inversion recovery sequences.
Findings Again, there are numerous foci of white matter plaque and gliosis in the perivetricular and deep white matter of the cerebral hemispheres, consistent with multiple sclerosis. There were previously two enhancing lesions: one caudal to the left lateral ventricle and the second superior to the left occipital horn. These are no longer enhancing. However, there is a single small rim-enhancing nodule, subtle, in the subcortical white matter of the posterior right frontal lobe on the coronal post gadolinium image #13. No other enhancing plaques can be identified. Overall, the number and extent of deep and subcortical white matter plaques are unchanged. Again, there are white matter lesions in the right pons, extending into the right cerebellar peduncle and mesencephalon bilaterally, unchanged. The upper cervical cord is unremarkable. The optic nerves appear normal. There are no abnormal extra-axial fluid collections. No shift to midline or mass effect.
Impression Two substantial lesions in the left cerebral hemisphere are no longer enhancing, but there is now a single small subtlely peripherally enhancing lesion in the subcortical white matter of the right frontal lobe. Otherwise unchanged plaques.
Peter Hathaway MD