How would you interpret the brain findings in this clinical contex.
Hypothalamic lesions do occur in MS, however as an isolated cranial finding would be unusual. Neuromyelitis optica could explain the cord and central lesions, but other possibilities need to be considered. Neurosarcoidosis could explain cord and central involvement but commonly enhance and involve meninges as well. Low grade glioma, germ cell tumour line or CNS lymphoma (but absence of contrast enhancement almost excludes the latter two in the absence of concurrent steroid therapy). Hamartoma is usually more midline and isointense and would not explain concurrent cord involvement.
The left hypothalamus, mammillary body, and immediately adjacent portion of the optic chiasm and optic tract are of abnormally high signal intensity. No restricted diffusion or abnormal contrast enhancement. Cerebral parenchymal signal intensity and architecture are otherwise normal. Ventricles and sulci are normal for the patient's age. Normal flow voids are seen from the major arteries at the base of the brain.