Clinical question: History of colon cancer, vision changes, headaches, dizziness with ambulation, loss of balance recently. Signs and symptoms: As above. Pre- and post enhanced brain MRI: Negative diffusion weighted series.Examination demonstrates few punctate foci of FLAIR hyperintensity in the periventricular and subcortical white matter which considering patient's stated age of 65 likely representing chronic changes of microvascular ischemic disease.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray-white matter differentiation otherwise.There is no detectable abnormal parenchymal, meningeal or calvarial enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and a normal pattern of enhancement.
1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.No detectable abnormal parenchymal, meningeal or calvarial enhancement.4.Extensive chronic sinusitis is noted. 