Multiple bilateral ovoid, periventricular and callososeptal T2 hyperintense, T1 hypointense lesions are demonstrated. The lesions are perpendicularly orientated to the ventricles. A right frontal juxtacortical lesion is also seen. There is moderate surrounding adjacent FLAIR / T2 high signal. Some of these are T1 hypointense. Several, however not all of these lesions demonstrate contrast enhancement.
A moderate to large area of right parietal cortical abnormality is seen, with oedema / T2 high signal and associated vasogenic oedema involving cortex and underlying white matter. There is vivid contrast enhancement within this region along with diffusion restriction (correspondingly low on ADC map) that mainly involves cortex. There is minimal mass effect for the degree of signal abnormality. No hemorrhage on EPI. No venous sinus thrombosis seen in non dedicated imaging. No increase in cerebral blood volume.
Conclusion: Overall MRI finding favour demyelination with a tumefactive plaque in the right parietal region and multiple smaller active plaques elsewhere-- particularly consider ADEM or MS variants (such as Marburg's). (Angiocentric) malignancy or cerebral vasculitis are differentials.