Clinical question: Assess for progression of posterior fossa lesion. Signs and symptoms: Spasticity. Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates multiple patchy foci of T2 hyperintensity in bilateral basal ganglia with interval progression since prior exam from 2012. Multiple tiny foci of FLAIR hyperintensity is also noted in the subcortical and periventricular white matter without convincing evidence of change.Tiny foci of T2 hyperintensity in bilateral thalami (left greater than right are better visualized on T2-weighted images) without significant change.Images through posterior fossa demonstrates extensive bilateral peroneal and pontine foci of FLAIR and T2 hyperintensity without convincing evidence of progression since prior exam. There are no detectable signal abnormality of cerebral cortex or cerebellum/vermis which is a similar observation as prior exam.Cortical sulci as well as ventricular system remain within normal size for patient of stated age and with maintained midline.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement and none of the above described foci of T2/FLAIR hyperintensity demonstrate enhancement. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series. Unremarkable images through the paranasal sinuses and mastoid air cells.
1.Negative diffusion-weighted images.2.Extensive bilateral basal ganglia and to a lesser degree bilateral thalami and pons and minimally in the subcortical and periventricular white matter foci of FLAIR hyperintensity without evidence of enhancement are again noted. There is progression of disease in bilateral basal ganglia since prior study. There is no convincing evidence of lesions in the corpus callosum or the cerebellar peduncles. Findings are more suggestive of chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise.