 There are multiple punctate to small foci of T2 hyperintensity within the subcortical white matter without restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing posterior fossa foci. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.
There are multiple punctate to small foci of T2 hyperintensity within the subcortical white matter without restricted diffusion, susceptibility abnormality, or enhancement. These findings are nonspecific, and the differential diagnosis would most likely include migraine sequelae, small vessel disease, or vasculitides. Given lesional locations and morphology, demyelination is felt to be less likely.