Clinical question: Evaluate brain, abnormal VNG- upbeating nystagmus. Dizziness. Signs and symptoms: Dizziness. Pre-and post enhancement MRI:No diffusion weighted abnormalities.Examination demonstrates patchy foci of flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglial, bilateral thalamus and a single focus in the pons. Considering patient's stated age of 69 the findings are highly suggestive of chronic small vessel ischemic strokes and mild to moderate decreased.There is mild prominence of supratentorial ventricles and subtle prominence of cortical sulci.Susceptibility MRI images demonstrate several punctate foci of susceptibility in bilateral cerebellar hemispheres, pons and bilateral cerebral hemispheres consistent with chronic microhemorrhages.Post enhanced images demonstrate no abnormal parenchymal or meningeal enhancement. There is normal enhancement of intracranial venous sinuses. No abnormal enhancement of the calvarium or the orbits.The signal voids of major intracranial arterial branches are identified.
1.Negative diffusion weighted images.2.Findings of mild to moderate chronic small vessel ischemic strokes as detailed. Several small foci of susceptibility in bilateral cerebral, cerebellar hemispheres and pons consistent with chronic microhemorrhages.3.No detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the orbits.