The mildly irregular heterogeneous hyperintense ovoid lesion centred medially in the left cerebellar hemisphere adjoining the middle cerebellar peduncle has remained stable in size and appearance when compared with the 6 months previous exam.
As previously, this demonstrates no overt pathologic enhancement and borderline diffusion restriction.
While the lesion may represent a demyelination plaque, ongoing follow-up MRI (including targeted spectroscopy) is recommended to exclude other lesions, such as a low-grade glioma.
Interestingly, a very subtle ill-defined juxta-cortical lesion has also remained stable superiorly in the left precentral gyrus.
Multiple tiny ill-defined enhancing foci scattered elsewhere through the brain (including the right and left pons, right frontal lobe subcortical to deep white matter and anterior left caudate nucleus head) have also remained stable.
These are not associated with any overt T2 hyperintense signal abnormality and are thought most likely to represent multiple capillary telangiectasias.