Clinical question: Recent seizure activity. Signs and symptoms: Left head/neck colonic/thymic movement. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse periventricular and to a lesser degree subcortical foci of FLAIR and T2 hyperintensity in bilateral cerebral hemispheres. Similar signal changes are also noted in bilateral basal ganglia and thalami. Although nonspecific considering patient's stated age of 77 findings also are present microvascular ischemic changes. There is no evidence of hemorrhagic changes with the findings. Small foci of chronic left cerebellar ischemic stroke in the distribution of left superior cerebellar artery is also noted.There is mild prominence of cortical sulci and the ventricular system which likely represent mild underlying parenchymal volume loss considering patient's stated age.No convincing evidence of cortical signal abnormality. No evidence of mass effect, midline shift or hydrocephalus.The signal void of major intracranial arterial branches are identified.Post contrast images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges and no enhancement of the calvarium or the retro-orbital spaces.There is exuberant pneumatization of paranasal sinuses and including extensive pneumatization of frontal bones/frontal sinuses with multiple patchy foci of mucosal thickening and retention cysts.
1.No acute intracranial process.2.Findings suggestive of chronic nonhemorrhagic small vessel ischemic strokes of moderate degree and a small chronic left cerebellar ischemic stroke as detailed.3.No detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.4.Exuberant pneumatization of paranasal sinuses with extensive pneumatization of frontal bones with multiple foci of mucosal thickening and retention cysts.