Clinical question: Clinical question: Rule out right frontal lesion. Signs and symptoms: LLE numbness/weakness and anosmia. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse scattered nonspecific foci of FLAIR and T2 hyperintensity along in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the right basal ganglia. Findings are nonhemorrhagic and demonstrate no abnormal enhancement. Although nonspecific this appearance is often result of microvascular ischemic changes considering patient's stated age.The anatomical morphology and the signal intensity of brain is otherwise within normal on all MRI sequences for patient's stated age and without detectable abnormal enhancement.The signal void in major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses remain within normal and with normal pattern of enhancement.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.Paranasal sinuses demonstrate acute on chronic right maxillary sinus disease and mild (L>R) chronic ethmoid sinus disease and unremarkable otherwise. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.No acute intracranial process.2.Findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Acute on chronic sinusitis as detailed.