Clinical question: 69-year-old male with head/neck cancer; evaluate for metastases or any abnormality. Signs and symptoms: Confusion. Pre-and post enhanced brain MRI:No acute intracranial process and negative diffusion-weighted images.Examination demonstrates few tiny foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres which are nonspecific and demonstrate no enhancement. This appearance however often represent microvascular ischemic changes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is within normal otherwise. Examination also fail to demonstrate any abnormal enhancement of brain parenchyma, meninges, calvarium or the retropatellar spaces to suggest metastatic disease.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and within normal pattern of enhancement.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.
1.No acute intracranial process and negative diffusion weighted series.2.Findings suggestive of minimal chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise and in particular without evidence of metastatic disease.