 Redemonstrated is increased T2/FLAIR signal intensity demonstrating a largely periventricular distribution, compatible with small vessel ischemic disease. However, this pattern is asymmetrically prominent adjacent to the right frontal and right anterior temporal horns where it is more confluence. Generalized ex vacuo effect on the right lateral ventricle suggests a chronic etiology for this finding, and the differential diagnosis includes an atypical pattern of small vessel ischemic disease, sequelae of an infectious/inflammatory insult, and demyelinating disease. Given differences in technique (3 Tesla acquisition for the comparison study, 1.5 Tesla acquisition on the current study) there has been no significant interval change.The remaining ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass, mass effect, or midline shift. The pituitary gland is normal in size. There are no foci of increased susceptibility. No diffusion-weighted abnormalities are identified. There are no extra-axial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. The hippocampi are within normal limits.
Stable asymmetric pattern of periventricular T2/FLAIR hyperintensity as described above, with generalized ex vacuo effect on the right lateral ventricle suggesting a chronic etiology. Differential considerations include an atypical pattern of chronic small vessel ischemic disease, prior infection/inflammation, and demyelinating disease among others. 