Female, 67 years old, with visual and auditory hallucinations. History of recurrent granulosa cell tumor of the ovary. Image quality is degraded by motion artifact. In addition, the examination was obtained without contrast at patient request. Within these limitations, no evidence of any significant parenchymal edema or mass effect is observed. No restricted diffusion is seen. There are numerous scattered foci of white matter T2 hyperintensity in both cerebral hemispheres, particularly in the periatrial regions, and in the left cerebellum. These findings have progressed mildly when compared to a prior examination from 2007. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.
Within the limitations of a motion degraded and noncontrast examination, no definite evidence of any acute intracranial process is seen. Moderately extensive scattered white matter lesions are redemonstrated with mild progression noted when compared to the prior examination 2007. These are favored to represent the sequelae of chronic microvascular ischemic disease, though other chronic etiologies could be in play. If clinical concern for encephalitis persists, repeat imaging in one to two weeks may be considered with contrast to improve imaging sensitivity.