CASE HISTORY/CLINIC:
43-year-old female with paresthesia.


FINDINGS:
The T2-w and FLAIR images show evidence of multiple oval, periventrikular lesions in the medullary layer as well as in the corpus callosum and pons. The above mentioned lesions appear hypointense on T1-w (black holes) and show dull spotty or ring-shaped enhancement after contrast administration


DIAGNOSIS:
Demyelinating foci of disseminated encephalitis that are partially enhancing, just like in an acute episode.


DIFFERENTIAL DIAGNOSIS:
Vascular lesions
ADEM (acute disseminated encephalomyelitis)
Metastases
Multiple abscesses
Toxoplasmosis


web resources:

1) ACR Learning file
2) AWMF
3) Medicine worldwide
4) MRI-Library