Clinical question:? Central lesion resulting in visual field defect. Signs and symptoms: Possible left hemianopia on visual field testing. Nonenhanced brain MRI:Negative diffusion weighted images.There are numerous small foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres, minimally in bilateral basal ganglia and pons with abdomen is soft hemorrhagic changes. Although the findings are nonspecific this appearance is often result of microvascular chronic ischemic strokes. Less likely possibility of demyelinating disease cannot be entirely excluded. Correlate with history and risk factors for both disease processes. There is no detectable cortical, cerebellar or vermian abnormalities.Ventricular system as well as the CSF spaces and cortical sulci remain within normal for stated age. There is no detectable mass in the midline and basal cistern is unremarkable.Signal void the major intracranial arterial branches are identified.Unremarkable calvarium, scalp, orbits and paranasal sinuses.
1.No acute intracranial process.2.No evidence of mass as these clinically questioned.3.Periventricular, subcortical, basal ganglia and pontine foci of flair hyperintensity although nonspecific the appearance is often result of microvascular ischemic disease. Less likely possibility of demyelinating disease cannot be entirely excluded.