Female, 82 years old, status post fall with unsteady gait and trouble with speech. Corresponding to the CT finding of hyperattenuation at the left parieto-occipital junction, the parenchyma demonstrates ill-defined T2 hyperintensity suggesting edema and a prominent clustering of susceptibility foci along with one subcentimeter focus of intrinsic T1 hyperintensity. There is some very questionable mild diffusion restriction corresponding to this general location.Elsewhere in the brain, numerous scattered foci of susceptibility are seen within both cerebral hemispheres sparing the cerebellum. Also noted is extensive patchy periventricular T2 hyperintensity. No other areas of significant parenchymal edema are detected. No large extra-axial fluid collections are seen. No definite pathologic enhancement is evident. The ventricles are normal in size and morphology.The bone marrow signal characteristics are within normal limits. Mucous retention cysts are seen in the left maxillary and right sphenoid sinus. A small amount of layering secretions are seen in the right maxillary sinus.
1.Parenchymal edema is seen at the left parieto-occipital junction with clustered foci of susceptibility likely representing blood product. One of these foci demonstrates intrinsic T1 hyperintensity suggesting subacute blood. There may be very vague associated restricted diffusion, but this is equivocal. Findings could represent petechial hemorrhage in the context of a resolving late subacute infarct or simply hemorrhage and associated edema.2.The large number of scattered foci of susceptibility elsewhere in the brain raises the possibility of amyloid angiopathy. In addition, there is evidence of fairly extensive chronic microvascular ischemic disease.