Clinical question: Thunderclap headache. Signs and symptoms: Transient loss of focus while driving and thunderclap headache. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates scattered confluent and punctate foci of FLAIR/T2 hyperintensity in bilateral subcortical and periventricular white matter as well as minimally in the bilateral basal ganglia. Findings although nonspecific considering the stated age of 75 this appearance is often represent chronic microvascular ischemic changes. There is mild prominence of the supratentorial ventricular system which could at least be partially secondary to underlying parenchymal volume loss.The cerebral cortex and cortical sulci as well as CSF spaces unremarkable and there is no deviation of midline.No detectable abnormal parenchymal or leptomeningeal enhancement on post enhanced series.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable and with normal pattern of enhancement.Unremarkable images through the orbits.Mild diffuse chronic sinus disease is noted. An 8 mm round T2/FLAIR hyperintensity lesion in the midline of superior nasopharynx suggestive of a benign Tornwaldt cyst is detected.
1.No acute intracranial process and negative diffusion weighted series.2.Findings of a without and with the procedure he cannot go for the wording of caliber abnormality is identified at the level of medicine moderate chronic nonhemorrhagic small vessel ischemic strokes in the supratentorial brain parenchyma.3.8 mm benign Thornwaldt cyst and mild diffuse chronic sinusitis as detailed above.