66 years, Female, headache. No intracranial mass or mass effect. There are multiple foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter. Few foci in the anterior temporal subcortical white matter as well as the external capsules also noted. 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. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Mild mucosal thickening is seen involving the anterior ethmoid air cells and minimal mucosal thickening involving the bilateral maxillary sinuses. Bone marrow signal and extracranial soft tissues are grossly unremarkable.
1. No intracranial mass or mass effect is appreciated on this MRI brain without contrast. No contrast was administered due to patient's GFR of less than 30.2. Multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter are nonspecific but likely related to chronic small vessel ischemic disease. Etiologies such as CADASIL may also be considered given lesions in the anterior subcortical white matter and external capsule; this is felt to be less likely given patient's relatively older age, but can be correlated with clinical findings.3. Mild paranasal sinus disease.