Clinical question: Dizziness; evaluate for structural lesions. Signs and symptoms: Dizziness. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates scattered foci of FLAIR hyperintensity in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglia, bilateral thalami (R>L) and bilateral paramedian pons. Findings are nonspecific and demonstrate no evidence of susceptibility signal changes. A few of the lesions demonstrate perpendicular access to the ventricular wall in their orientation. In this age group this appearance is often result of microvascular ischemic changes however less likely possibility of demyelinating disease considering and also be consideredThere is no detectable signal abnormality of the cortex or the cerebellum/vermis. This signal void in major intracranial arterial branches are identified. Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.
1.No acute intracranial process.2.Findings highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild to moderate degree both in supra and infratentorial brain parenchyma. Remote possibility of demyelinating disease cannot be entirely excluded.3.Unremarkable nonenhanced brain MRI otherwise for patient's stated age of 68.