Diagnosis: HeadacheClinical question: cause of headaches , leptomeningeal disease vs stokeSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is generalized brain atrophy present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is heterogeneous marrow signal present within the visualized upper cervical spine
1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction.3.There is no evidence for leptomeningeal disease.4.There is heterogeneous marrow signal in the visualized upper cervical spine. This is a nonspecific finding . Please correlate with patient's clinical history for chronic disease or myeloproliferative disorder or lymphoproliferative disorder.