Clinical question: Evaluate for structural/enhancing lesions. Signs and symptoms: Had a second episode of severe headache with nausea and vomiting. Has embolic strokes on prior MRI exam. May have vasculitis. Pre and post enhanced brain MRI:There is no detectable acute intracranial process and diffusion weighted images are negative.Examination demonstrate multiple tiny foci of FLAIR hyperintensity at the site of previously known acute ischemic stroke is without evidence of hemorrhagic changes. Findings are noted in the right occipital, right basal ganglia, right and left posterior temporal lobes. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray-white matter differentiation. There is mild prominence of cerebellar and vermian folia for patient's stated age similar to prior exam.The signal void of major intracranial arterial branches are identified and unremarkable.Post contrast images demonstrate no abnormal parenchymal, leptomeningeal, calvarial or retro-orbital enhancement. There is normal signal intensity and enhancement of intracranial venous sinuses.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.
1.No acute intracranial process and negative diffusion weighted series.2.Tiny foci of FLAIR hyperintensity at the sites of previously known multiple embolic strokes are noted and without evidence of mass effect or hemorrhagic changes.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.