Male, 71 years old, with left-sided paresthesias. Patchy periventricular and subcortical T2 hyperintensity is seen, a nonspecific finding. No definite evidence of restricted diffusion is noted. There is a small focus of bright diffusion signal in the right doral pons but with no clear ADC correlate. No parenchymal edema or mass effect is detected. There are a few punctate foci of susceptibility scattered throughout the brain compatible with chronic micro-hemorrhage. No acute intercranial hemorrhage or any abnormal extra-axial fluid collections are seen. Diffuse prominence of the sulci likely reflects a mild degree of parenchymal atrophy. The ventricular system is within normal limits for size and morphology.
1. Patchy white matter signal abnormality is nonspecific but most commonly reflects chronic microvascular ischemic disease.2. No definite evidence of acute ischemia is seen. A small focus of bright diffusion signal within the right dorsal pons does not show a clear ADC correlate and therefore does not clearly represent restricted diffusion. This may indicate an imaging artifact, or T2 shine through of a chronic lesion, or perhaps a late subacute resolving ischemic lesion. The ascending spinothalamic tract does traverse through this area of the pons which would coincide with the reported symptomatology. Correlation with timing and nature of symptomatology is suggested. 