New horizontal double vision and headache. There is mild scattered cerebral white matter T2 hyperintensity. There also appears to be a punctate focus of restricted diffusion in the left posterior cingulate gyrus without correlate on the other sequences. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but likely represents chronic small vessel ischemic disease. An apparent punctate focus of restricted diffusion in the left posterior cingulate gyrus without correlate on the other sequences is likely artifactual, although an acute infarct is a potential consideration.