Clinical question: Structural lesion causing headache. Signs and symptoms: Diffuse sharp headache with left sharp trigeminal distribution pain. Pre-and enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a few punctate foci of nonspecific flair hyperintensity in the subcortical and periventricular white matter bilateral seen hemispheres. Although nonspecific in proper clinical setting these findings could represent mild chronic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma is otherwise entirely within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement. The signal 80 the major intracranial arterial branches are identified.The signal intensity intracranial venous sinuses are within normal and with normal pattern of enhancement. Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells/middle ear cavities demonstrate normal pneumatization signal.
1.Negative diffusion weighted images.2.Few nonspecific punctate foci of flair hyperintensity the the subcortical and periventricular white matter which in proper clinical setting clips are present minimal chronic small vessel ischemic strokes.3.Unremarkable pre-and post enhanced brain MRI otherwise.4.Unremarkable images through the orbits, paranasal sinuses and well pneumatized mastoid air cells and middle ear cavities.