Posttraumatic headache, unspecified, intractable. 17 years, Male, headache and dizziness. No intracranial mass or mass-effect. There are areas of cortical volume loss with adjacent T2/FLAIR hyperintensity involving the lateral cortex of the right lateral temporal as well as the inferior frontal lobes. There is susceptibility artifact related to patient's braces which limits evaluation of the bilateral frontal lobes on the susceptibility weighted and diffusion-weighted sequences. There is a punctate focus of susceptibility involving the left occipital deep white matter. Subtle focus of susceptibility is also questioned in the left cerebellar hemisphere. No surrounding edema. No evidence of acute ischemia or hemorrhage. No extra-axial collections. Major flow-voids are preserved. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable within the limits of the susceptibility artifact from patient's braces.
1. Small areas of encephalomalacia involving the cortex of the right inferior and right lateral temporal lobes may be related to prior trauma. There are also punctate foci of susceptibility in the left occipital white matter and left cerebellar hemisphere which are compatible with chronic microhemorrhages. These are nonspecific but may be also be related to remote trauma.2. Brain parenchyma appears otherwise unremarkable without intracranial mass or mass effect.