Clinical question: 49-year-old female with history of breast cancer and headaches, concern for mass effect versus pseudotumor cerebri. Signs and symptoms: Pulsatile headaches. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates small scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the basal ganglia. Findings are not hemorrhagic and demonstrates no enhancement. Although nonspecific this appearance is often represent chronic microvascular ischemic changes. Considering patient's provided age less likely possibility of demyelinating disease cannot be entirely excluded.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is otherwise normal on all MRI sequences. Post enhanced images are also negative for any detectable abnormal enhancement of brain parenchyma, leptomeninges or the calvarium to suggest metastatic disease.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable signal intensity of the calvarium and soft tissues of the scalp without abnormal enhancement.All paranasal sinuses are well-pneumatized and without evidence of disease.
1.Negative diffusion weighted series.2.Findings suggestive of mild chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI.