 There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several nonspecific punctate foci of increased T2/FLAIR signal within the supratentorial subcortical and periventricular white matter. There is also an ill-defined larger area of confluent increased T2/FLAIR signal in the right periatrial white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.
Nonspecific punctate as well as confluent areas of white matter signal abnormality. Differential considerations include chronic small vessel ischemic changes, demyelinating disease, vasculitides, and other less likely etiologies. Recommend follow-up brain MRI without and with intravenous contrast in 3 months for further characterization and to assess interval change.