Left-sided headache for 3 months, wakes up from sleep. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, and appear mildly increased in the interval. Compared to 3/5/2013, there is minimal interval increase in ovoid focus of flair hyperintensity involving the left periatrial white matter measuring approximately 16 x 16 mm. There is also a new T2/FLAIR hyperintense focus involving the left frontal corona radiata. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. No evidence of intracranial mass effect, hemorrhage, or acute ischemia. 2. Scattered foci of T2/flair hyperintensity in the periventricular and subcortical white matter are nonspecific. There is a new focus in the left frontal corona radiata. There is also an ovoid T2/FLAIR hyperintense lesion involving the left periatrial white matter which appears minimally larger compared to 3/5/2013. Overall findings are favored to be vascular related (atypical pattern of small vessel ischemic disease) with mild progression. Inflammatory vasculopathy or demyelinating disease (less likely in this age group) can also be considered. 