 There are several punctate foci of T2 hyperintensity primarily involving the subcortical white matter located within the frontal lobes. These are not associated with mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions within the posterior fossa structures.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Incidental note is made of a small left occipital developmental venous anomaly without MRI evidence of associated cavernous malformation. Otherwise flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of two, 1 cm-sized, foci within the subcutaneous scalp tissues overlying the right paramedian parietal bone as well as left parietal bone, with MRI features consistent with sebaceous cyst.
There are nonspecific punctate foci of T2 hyperintensity primarily involving the subcortical white matter located within the frontal lobes which are not associated with mass effect, restricted diffusion, susceptibility abnormality, or enhancement. For a patient of stated age 53 years, this is most likely secondary to chronic small vessel disease. The differential diagnosis would also include changes from migraine headaches or sequelae of remote head injury. Given lesional appearance and locations, demyelination is felt to be unlikely.