Findings:
Multiple T2/FLAIR hyperintensities are identified scattered in the paraventricular and subcortical cerebral white matter. On the sagittal plane, lesions extending up through corpus callosum in a characteristic “Dawson`s fingers” appearance in keeping with a diagnosis of chronic demyelinating disease. Further foci of demyelination are also noted in the left middle cerebellar peduncle and the left cerebellar white matter. No involvement of the basal ganglia or the brain stem. The lesions show no diffusion restriction.
A well defined lesion showing characteristic popcorn appearance with heterogenous T1w and T2w signal intensity and peripheral T2 hypointense margins is noted in the left inferior frontal gyrus, measuring approximately 11 x 9 mm and showing prominent blooming on the SWI sequence.
A circular, mixed solid and cystic mass centered in pineal region is noted, measuring approximately 8 x 9 mm with mild diffusion restriction. No associated mass effect.
A small lesion with intracystic high T1 signal is noted in the midline within the pituitary fossa measuring 5 mm, in keeping with a small Rathke’s cleft cyst.
Diffusion restriction and increased T2 signal intensity of the retrobulbar intra-orbital segment of the left optic nerve, mildly extending to the intracranial segment without involvement of optic chiasm.
The right optic nerve is unremarkable.
The paranasal sinuses and mastoid air cells are clear.
No bony abnormality is seen. The craniocervical junction is normal.
Conclusion:
Features in keeping with multiple sclerosis with multiple demyelinating plaques involving both cerebral and the left cerebellar hemispheres.
Left-sided optic neuritis.
Incidental finding of a left fronto-opercular cavernoma and a small Rathke’s cleft cyst.
Additionally, mixed solid and cystic lesion of the pineal region, suspicious of a small pineocytoma. No mass effect or hydrocephalus.
Further surveillance with contrast enhanced MRI of the brain is advised.