Clinical question: Cause of facial numbness and dizziness. Signs and symptoms: Facial numbness and dizziness. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates multiple small foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and including the right external capsule. The largest lesion is in the right periventricular white matter at the level of trigone of right lateral ventricle. Measuring approximately 10 x 7 mm in transaxial dimensions and containing a tiny focus of chronic hemorrhage. Although the findings are nonspecific and this appearance is often result of microvascular ischemic changes. The signal intensity of the brain is otherwise within normal on all MRI sequences. The sacral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is unremarkable.The signal void of major intracranial arterial branches are identified and unremarkable. The signal intensity of intracranial venous sinuses remains within normal.Calvarium, soft tissues of the scalp, orbits and mastoid air cells are unremarkable. Mild bilateral ethmoid chronic sinus disease and unremarkable paranasal sinuses otherwise.
1.No acute intracranial process and negative diffusion weighted images.2.Multiple small foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres with one lesion demonstrating minimal chronic hemorrhagic changes as detailed. Findings are concerning for chronic small vessel ischemic strokes. Correlate with history and risk factors and consider follow-up with an enhanced imaging to exclude other white matter lesions if clinically deemed pertinent.3.Unremarkable nonenhanced brain MRI otherwise.