Clinical question: evaluate for bleeding, characterize hypoattenuating genu lesion seen on CTSigns and Symptoms: R eye pain/R sided headache, bilateral blurred vision x1-2 daysDiagnosis: Headache Headache MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small 6 mm focus of diffusion restriction present along the right superior temporal gyrus near to the junction with the inferior parietal lobule. There is a more subtle 2.5 mm focus of diffusion restriction present along the right inferior parietal lobule close to the junction with the occipital lobe. These can also be identified on the FLAIR MRI images.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR punctate hyperintense foci are present in the thalami. Patchy T2 and FLAIR hyperintense lesions are present in the brainstem.There is a heterogeneous focus of T2 and FLAIR signal hyperintensity along the genu of the corpus callosum eccentric towards the left side measuring approximately 30 x 10 mm axial dimensions. It is low signal on T1-weighted imaging but heterogeneous. It does not enhance following gadolinium administration. It does not appear to be associated with any significant diffusion restriction. There is no associated susceptibility effect appreciated.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .
1.There is a heterogeneous looking lesion along the genu of the corpus callosum. It is not associated with any contrast enhancement. It is nonspecific. Differential considerations include demyelination as well as a low-grade glioma and prior injury.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. Additional lesions are present in the brainstem as well as the thalami.3.There are small foci of diffusion restriction present in the right superior temporal gyrus and adjacent inferior parietal lobule. The possibility that these are related to microinfarcts is raised. These correspond to the territory of the right angular artery.