Clinical question: Evaluate for structural lesions. Signs and symptoms: Worsening headaches. Nonenhanced brain MRI:Negative diffusion weighted series.Flair and T2 weighted images demonstrate few tiny foci of hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres, tiny foci in the left external capsule which are nonspecific however in proper clinical setting they could represent mild chronic small vessel ischemic strokes. No prior exams available for comparison. There is also very mild prominence of vermian folia for age. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is otherwise unremarkable.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized. Unremarkable images through the orbits.
1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.Unremarkable exam otherwise.4.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.