Blurry vision. Suggestion of intracranial mass on head CT scan. Though the study was initially protocoled with and without intravenous contrast, the patient did refuse to complete the examination. Only precontrast images are available. Also, neck MRA was not performed.Brain MRI:There is confluent T2-hyperintense signal involving the left occipital lobe with anterior extension into the medial right temporal lobe.. The signal abnormality is limited to the white-matter but the overlying cortex is mildly T1-hyperintense. Most of the associated diffusion signal is T2-shine through. The right occipital lobe shows a less extensive signal abnormality, compared to the left. The signal abnormality is predominantly in the cortex which is swollen and T2-hyperintense and shows diffusion restriction. The occipital abnormalities caused mild mass-effect manifested by mildly closed occipital sulci.Two foci of T2-hyperintense signal, also with no diffusion restriction, are present in the left thalamus.Susceptibility-weighted imaging is notable for focus of susceptibility effect in the right thalamus with no associated edema which may represent mineralization or hemosiderin deposition. There is no hemorrhage in the occipital abnormality.Patchy frontoparietal white-matter T2-hyperintense lesions without diffusion restriction are nonspecific but likely reflect chronic microvascular ischemia. There is generalized mild brain volume loss manifested by expansion of the ventricles and the other CSF-containing spaces. There is no midline shift or brain herniation.There is mild maxillary and ethmoid mucosal thickening. There is a chronic right orbital medial blowout fracture.Head MRA:There is no flow-limiting stenosis, occlusion or aneurysm of the major intracranial arteries, including the posterior circulation.
1.The abnormality in the left occipital lobe, with temporal extension, and left thalamus are most compatible with subacute infarcts. The abnormality in the right occipital lobe is more recent given the associated cortical diffusion restriction and matching ADC hypointensity. There is no intracranial hemorrhage or herniation. Punctate susceptibility effect in the right thalamus without edema probably represent mineral deposition or hemosiderin staining. In addition, there are findings of chronic microvascular ischemia in the cerebral white-matter.2.Head MRA shows no significant stenosis, occlusion or aneurysm of the major intracranial arteries.3.Incidental findings include mild mucosal thickening in the paranasal sinuses which is nonspecific and a chronic right medial orbital blowout fracture.