Female, 61 years old, with altered mental status, seizure. No restricted diffusion is seen. Numerous scattered foci of periventricular and subcortical T2 hyperintensity are seen within the cerebral hemispheres. The caudate heads and putamina are also involved, left side more than right. Fairly conspicuous central pontine T2 hyperintensity is noted as well. No evidence of edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. On postcontrast images, there is no evidence of pathologic parenchymal or extra-axial enhancement.
Patchy T2 hyperintensity is seen in the periventricular white matter, basal ganglia and central pons. The differential for these findings is broad and would include sequelae of small vessel ischemic disease, vasculitis, demyelination, or toxic/drug exposure. Similar features can also be seen in osmotic demyelination within the context of an electrolyte derangement.