Male, 53 years old, with seizures. Numerous scattered small foci of T2 hyperintensity are identified within the subcortical and periventricular white matter as well as the basal ganglia, thalami and brainstem. Many of these lesions are hypointense on FLAIR and T1-weighted images which suggests tissue loss.No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected. No large intracranial hemorrhages or abnormal extra axial fluid collections are detected. The ventricles and sulci are mildly prominent compatible with generalized parenchymal volume loss, but are otherwise unremarkable.
1. Numerous scattered small white matter lesions are identified in the cerebral hemispheres bilaterally. These most likely represent chronic microvascular ischemic lesions, though a complete differential would include the sequelae of demyelinating or vasculitic diseases as well as sequelae of prior inflammation.2. No evidence of acute intracranial abnormality is seen. No mass, edema or other additional specific finding is seen to account for the patient's seizures.