Headaches, evaluate for progression of periventricular signal abnormality. Again seen is aconfluent hyperintense T2/flair signal in the bilateral centrum semiovale, corona radiata and basal ganglia, including a focus of CSF-like signal in the right centrum semiovale, which have been unchanged in extent since prior exam. There is however a T2 hyperintense focus/cystic encephalomalacia involving the left frontal corona radiata, axial T2 image 19 of series 7 which appears new since prior. There is also a prominent focus of susceptibility effect along the upper aspect of the left caudate head which is not seen on the prior study. There is a tiny focus of susceptibility within this region on the prior study. Punctate focus of susceptibility in the left posterior frontal corona radiata is not definitively seen on prior and may be new although differences in susceptibility-weighting technique limit direct comparison. No evidence of acute infarct, acute hemorrhage, intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Extracranial soft tissues structures are unremarkable. Mucous retention cysts again seen in the left greater than right maxillary sinuses.
Extensive white matter signal abnormality is largely stable compared to 2/26/2010; however, there is small focus of cystic encephalomalacia involving the left frontal corona radiata and an adjacent chronic hemorrhage which appear new, suggesting mild progression of disease. Differential is broad but favor advanced chronic small vessel ischemic disease. Given a patient's age, entities such as Binswanger and CADASIL could be considered, for example; although characteristic anterior temporal lesions associated with CADASIL are not seen. Other white matter diseases such as chronic demyelinating disease are also in the differential although felt to be less likely.