68-year-old female with history of lung cancer with brain metastases presenting with intermittent aphasia concerning for TIA/stroke. Evaluate for hemorrhage or stroke. Extensive low-attenuation is seen within the subcortical and periventricular white matter, compatible with prior therapy for brain metastasis versus small vessel ischemic disease. No intracranial hemorrhage or definite cortical stroke is evident, though contrast enhanced MRI is recommended for further evaluation if clinical suspicion remains high. The remaining cerebral and cerebellar hemispheres and brainstem demonstrate normal attenuation and morphology. The ventricles are midline, with normal alignment morphology. No abnormal extraction fluid collections are evident.The calvarium and other osseous structures are normal in appearance, with no evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
Diffuse white matter disease which may be due to prior therapy for brain metastases or small vessel ischemic disease. If clinical concern for acute stroke remains, MRI is recommended.