Radiology Report (2/18/2008 – Vision Problems)
This is my radiology report following my scan on February 18, 2008. I had this scan due to a loss of vision in both eyes.
How about patient reports loss of vision with blind spots?! I would have thought that would have been on the order too, but you never know.
I always like the “reports Lyme disease.” Nice.
Exam: MR brain pre and post IV gadolinium.
Indication: A 32-year-old male who reports Lyme disease, but the physician’s
order states multiple sclerosis. Patient reports blurred vision.
Technique: Multiplanar, multisequence MR images of the brain were obtained
pre and post IV gadolinium.
Comparison: Previous brain MR dated 08/29/2007 demonstrated multiple
nonenhancing white matter lesions throughout the supratentorial brain.
Findings: Diffusion-weighted images demonstrate no areas of diffusion
restriction to suggest acute ischemia. There are some hyperintense regions
diffusely throughout the brain on the sequence, which are actually related to
T2 shine through, described below.
Multiple scatter foci of T2 and FLAIR signal abnormality are redemonstrated
throughout the subcortical and periventricular white matter. Overall, these
have increased in size and number when compared to prior and are compatible
with worsening. Linear signal abnormality on the sagittal FLAIR images at the
callosal septal interface are also demonstrated. The largest lesion is in the
right posterior limb internal capsule extending into the midbrain. It
measures 1.4 cm and demonstrates pathologic enhancement. This is larger than
when compared to the previous exam. A 1.3 cm right frontal periventricular
white matter lesion is now seen on series 5 image 18. The previously seen
largest lesion within the right frontal superior gyrus measured 1.7 cm
previously, which now measures 0.8 cm. Multiple infratentorial lesions are
now seen. For example, a 0.8 cm lesion is seen in the right cerebellum with a
lesion in the right medulla and left middle cerebellar peduncle.
On the postgadolinium images, there are at least four foci of pathologic
enhancement, the largest is in the right posterior limb internal capsule.
there is also enhancement in the bilateral frontal lobe lesions and left
posterior frontal periventricular white matter lesion.
A dedicated orbit protocol MR was not performed but there is abnormal
hyperintense signal in the right optic tract which could explain patient’s
No hydrocephalus, midline shift, or intracranial hemorrhage.
Interval increase in size and number of the multiple white matter lesions
throughout the supra and infratentorial brain as can be seen in Lyme disease
or MS. Evolution in enhancement of lesions, with multiple, new enhancing
lesions as detailed above.