Clinical question: Urinary incontinence, gait instability. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate several small foci of flair/T2 hyperintensity entirely in the subcortical white matter of cerebral hemispheres. Findings are more extensive in bilateral frontal lobes and with lesser degree in the parietal lobes. There is normal signal intensity and morphology of cerebral cortex, bilateral basal ganglia, thalami, midbrain, pons, medulla and cerebellum/vermis. There is slight prominence of vermian and to a lesser degree cerebellar folia for patient of stated age of 48. Possibility of mild underlying parenchymal volume loss cannot be entirely excluded. Post enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma, leptomeninges, barium, tissues of the scalp or the orbits.There is visualization of the signal void of major intracranial arterial branches. The signal intensity of the intracranial venous sinuses is within normal and with normal pattern of enhancement.
1.No acute intracranial process.2.Several nonspecific foci of flair hyperintensity only in the subcortical white matter of bilateral frontal and to a lesser degree bilateral parietal lobes. A proper clinical setting this finding could represent mild chronic small vessel ischemic strokes however considering patient's stated age possibility of a demyelinating process cannot be entirely excluded. The signal intensity of brain otherwise remains within normal in all MRI sequences and without detectable abnormal enhancement. 3.Slight prominence of the vermian and to a lesser degree cerebellar folia for patient's stated age of 48 is noted.