Syncope and collapse: evaluate right lower midbrain lesion, see CT reportSigns and Symptoms: syncope, dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the brainstem and thalami as well as the basal ganglia. In particular lesion in the right midbrain is a low signal on FLAIR and T1, high signal on T2 and not associated with diffusion restriction. This could represent a perivascular space or prior lacunar infarct.No foci of diffusion restriction are appreciated within the brain parenchyma.On susceptibility imaging there are 10-15 punctate foci of signal loss in the subcortical white matter located in the parietal lobes and temporal lobesNo abnormal mass lesions are appreciated intracranially. 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 demonstrate a mucous retention cyst in the right maxillary sinus and mild mucosal thickening elsewhere. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is medial deviation of the right lamina papyracea. This could be related to a prior right orbital medial blowout fractureThere is a small subdural effusion present which is likely related to volume loss.
1.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami and a subtle ganglia are also likely vascular related . In particular the lesion in the right lower midbrain most likely represents an old lacunar infarct.3.Subcortical microhemorrhages of a mild degree are present. Their distribution in the subcortical white matter would raise the question of amyloid angiopathy. They predominate in the temporal lobes and to a lesser degree parietal lobes.