 MRI brain: There is no diffusion abnormality. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, but also in the anterior temporal lobes in the high frontal vertex. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are several punctate foci of susceptibility predominantly in the bilateral basal ganglia indicating chronic microhemorrhage. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA brain: Motion degraded exam. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. Bilateral small P-comm arteries are present. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.
1. No evidence of acute ischemia.2. Numerous white matter lesions are seen, predominantly in the periventricular regions but also in areas less typical for routine small vessel ischemic disease. Atypical vasculopathy or arteriopathy such as CADASIL would be in the differential in addition to other non-vascular inflammatory processes.3. Motion degraded MRA. No significant intracranial vaso-occlusive disease.