Episodic loss of balance; no falls; look for occult cerebrovascular disease. There is no evidence of intracranial hemorrhage or acute infarct. There is a nonspecific punctate focus of high T2 signal in the right peritrigonal white matter and minimal more diffuse periventricular white matter T2 hyperintensity bilaterally. There is heterogeneous enhancement of the pituitary gland, which is otherwise not particularly enlarged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the left maxillary sinus. There is a punctate Thornwaldt cyst in the nasopharynx.
1. Nonspecific punctate focus of high T2 signal in the right peritrigonal white matter and minimal more diffuse periventricular white matter T2 hyperintensity bilaterally, which may represent chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage or acute infarct. 2. Apparent heterogeneous enhancement of the pituitary gland may be attributable to an underlying pituitary microadenoma, for example. Follow up with dedicated pituitary MRI may be useful for further evaluation.