65-year-old woman with history of colon cancer and seizures. MR brain attempted on 11/28/2016, not completed due to developing seizure. There is a punctate focus of diffusion restriction in the anterior limb of the left internal capsule (4/17) in the vascular distribution of an MCA perforator branch. There is no associated signal abnormality on T2 or FLAIR images. No evidence of surrounding edema or enhancement. There are no additional areas of diffusion restriction.A few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age and the medial temporal lobes appear normal.On postcontrast images, there are no foci of abnormal enhancement. There is no intracranial mass or mass effect. The sella is partially empty. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. There is a punctate focus of susceptibility artifact in the left occipital lobe without edema or enhancement, likely calcification or hemosiderin deposition.There is mild mucosal thickening of the right maxillary sinus, otherwise the paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1.No evidence of intracranial metastasis or acute hemorrhage.2.Punctate diffusion signal abnormality in the anterior limb of the left internal capsule which could represent an acute or subacute small vessel infarct of a left MCA perforator branch. This finding is of questionable clinical significance.