Clinical question: History of PCNSL, memory with new balance and memory problems. Signs and symptoms: NHL, memory loss, imbalance.. Pre and postcontrast enhanced brain MRI: Unremarkable diffusion weighted images.Examination demonstrates diffuse periventricular, subcortical, bilateral basal ganglia and extensively of pontine foci of FLAIR/T2 hyperintensity with mild interval progression since prior exam. Additionally foci of hemorrhagic encephalomalacia in the left posterior parietal-occipital region is present without change since prior exam. Also stable since prior exam is a focus of hemorrhagic encephalomalacia in the left posterior temporal-parietal region without abnormal enhancement.There is no detectable signal abnormality of cerebellar or vermian parenchymal.The supratentorial ventricular system remain stable and within normal for age and with maintained midline. The signal void of major intracranial arterial branches are identified. Incidental note is made of anatomical variation of partially empty sella.There is no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the retro-orbital spaces. There is evidence of a small left posterior temporal-parietal craniotomy without change.
1.No evidence of an acute finding.2.Extensive patchy confluent foci of FLAIR hyperintensity in the subcortical and periventricular white matter, bilateral basal ganglia and extensively within the pons with slight interval progression since prior study. Although nonspecific findings could represent chronic nonhemorrhagic small vessel ischemic strokes.3.Stable foci of hemorrhagic encephalomalacia in the left posterior temporal-parietal as well as left posterior parietal-occipital regions without abnormal enhancement.