Clinical question: Sudden syncopal episodes which patient experiences and has sudden episodes in which she falls asleep, often at the wheel. Known scleroderma.? CNS etiology for these episodes. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates patchy small varying sized confluent foci of FLAIR/T2 hyperintensity in the subcortical and periventricular white matter, minimally in bilateral basal ganglia and pons. Findings are nonspecific however in proper clinical setting could represent chronic small vessel ischemic strokes. Findings demonstrate no cortical susceptibility signal changes.There are no similar lesions within the corpus callosum, cerebellar peduncles or the cerebellum. Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces otherwise for stated age.A signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits and paranasal sinuses.
1.Negative diffusion-weighted images.2.Extensive patchy confluent FLAIR and T2 hyperintensity in periventricular and subcortical white matter and to a lesser degree in bilateral basal ganglia and pons as detailed. Findings are nonspecific however they likely representing chronic nonhemorrhagic small vessel ischemic strokes. There are no prior exams for comparison. To entirely exclude other white matter lesions follow-up with enhanced imaging is recommended.3.Unremarkable exam otherwise.