Does this patient meet criteria for multiple sclerosis?
Not radiologically - although there are many demyelinating lesions (both supratentorial and spinal) this is the first clinical presentation with a neurological deficit. None of the lesions were enhancing with contrast administration so the McDonald criterion for dissemination in time has not been met. However, with further history, there were previous episodes of numbness that where medical attention was not saught, but were consistent with demyelination so the clinical diagnosis of MS was confirmed.
Multiple periventricular and subcortical lesions with high signal on T2 sequences. Heavy lesion load in posterior corpus callosum. None of the lesions display diffusion restriction and they are non-enhancing with contrast.
Intra-axial left cerebellar lesion (about 4 cm). Minor mass effect. No contrast enhancement but minor restriction. Striated internal appearance but no uptake post-contrast. Given history of Cowden disease, this is likely a low-grade dysplastic cerebellar gangliocytoma (Lhermitte-Duclos-Cowden syndrome).