Clinical question: Punctate hemorrhage on CT? Signs and symptoms: Dizziness and ataxia. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate no convincing evidence of intracranial hemorrhage. Note should be made however that MRI is insensitive for detection of subtle isolated subarachnoid hemorrhage.FLAIR and T2-weighted images demonstrate scattered foci of FLAIR and T2 hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres. Minimal similar findings are also noted in bilateral basal ganglia and pons. Although nonspecific this appearance is often result of microvascular ischemic changes. Correlate with history and risk factors. Remote possibility of demyelinating disease cannot be entirely ruled out considering patient's stated age.Mild prominence of cortical sulci and lateral ventricles suggestive of underlying parenchymal volume loss.All CSF cisterns remain widely patent.The signal void of major intracranial arterial branches are identified.There is normal anatomical variation of a partially empty sella. Unremarkable calvarium and soft tissues of the scalp, unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.No evidence of intracranial hemorrhage and negative diffusion weighted series.2.Diffuse foci of FLAIR hyperintensity in the subcortical, periventricular and minimally in bilateral basal ganglia and pons suggestive of chronic small vessel ischemic strokes. Correlate with history and risk factors and consider follow-up with enhanced imaging to exclude other white matter lesions if clinically warranted.3.Unremarkable nonenhanced brain MRI otherwise.