Female, 54 years old, with history of vasculitis/arteritis and now with multifocal areas of restricted diffusion on MRI. Multiple new punctate foci of diffusion restriction are evident in the cerebral hemispheres, predominantly affecting the peripheral tissues at the convexities. The inferior lobes and the deep structures are spared. A large area of ill-defined FLAIR hyperintensity has also progressed in the left corona radiata with subtle corresponding DWI hyperintensity.A chronic hemosiderin stained lacunar infarct of the left basal ganglia is unchanged. Small T2 hyperintense foci in the right basal ganglia are also unchanged and favored to represent perivascular spaces versus lacunar infarcts. Minimal scattered foci of T2 hyperintensity are unchanged and nonspecific. No evidence of significant generalized mass effect is seen. No acute intracranial hemorrhage is detected. An 8 mm extra-axial enhancing lesion along the right cerebral dura is unchanged. Ex vacuo dilatation of the left lateral ventricle is again seen. Ventricular size and morphology are unchanged. A subcutaneous cyst is redemonstrated in the left parietal scalp.
1.Interval development of multiple small foci of acute ischemia involving primarily the peripheral tissues of the cerebral convexities.2.Progressive ill-defined T2 signal abnormality within the left corona radiata with questionable minimal diffusion restriction. This could reflect subacute to chronic ischemic injury as well.3.Chronic lacunar infarct of the left basal ganglia is unchanged.4.Small enhancing extra-axial lesion along the right cerebral dura is unchanged and may represent an incidental meningioma.