Syncope and collapse [R55] / Dizziness and giddiness [R42] / Headache [R51], Reason for Study: ^Reason: Eval for mass or ischemia History: Syncope, dizziness, vertigo There is a focal T1 high signal intensity with subtle or no enhancement on post Gad axial image (about 3mm x 4mm on axial post-enhanced scan) on the left frontal lobe deep white matter just lateral aspect of genu of the left caudate nucleus. There is no other enhancing lesion seen on this scan. The lesion is not seen on other image sequences. There is no MR evidence of surrounding edema. The lesion is not conspicuous on other imaging sequences. In addition, the lesion is not seen on the thin section T1 weighted 3D sequence either. Therefore, this lesion is likely to be an artifact. However, short term follow up imaging is recommended to exclude possibility of other diagnostic possibilities such as tumorous or infectious lesion. Underlying brain shows multifocal scattered FLAIR high signal intensity lesions which are non specific. Comparing to prior scan, the numbers of FLAIR high signal intensity lesions appear to be increased since prior scan indicating progression of non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. About 3mm sized focal T1 high signal intensity lesion with subtle or no enhancement on the left frontal lobe deep white matter, likely represent an artifacts. However, short term follow up is recommended to exclude other possibilities.2. No evidence of acute ischemic or hemorrhagic lesion.3. Non specific small vessel ischemic disease slightly progressed than prior scan.