59 years, Female, headaches, visual hallucinations. Evaluate for evidence of CADASIL. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are multiple scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. There is mild global parenchymal volume loss. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses are clear. There is mild left and minimal right mastoid air cell opacification. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.
1. No evidence of acute infarct, intracranial hemorrhage, mass, or mass effect. 2. Multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific and may reflect mild chronic small vessel ischemic disease, prior inflammation, or less likely demyelination. These foci can also be seen with migraines. Distribution of these lesions is not particularly suggestive of CADASIL as questioned.