Clinical question: Thunderclap headache. Signs and symptoms: Transient loss of focus while driving and thunderclap headache. The CSF spaces are appropriate for the patient's stated age of 75 with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities in the ethmoid air cells and some mucosal thickening in the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental notes are made of partial empty sella and an 8mm Thornwaldt cyst. These are likely of little clinical significance.
1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They are associated with increasing age and most likely vascular related.