24-year-old woman, 16 weeks pregnant and with history of lupus, now with severe headache. There are a few, scattered foci of punctate diffusion restriction and increased T2/FLAIR signal in the bilateral cerebral and cerebellar hemispheres at the gray-white junction (601/19 and 21). There is no intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several additional foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age. The major flow voids are preserved.Sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRV BRAIN
1.Scattered punctate white matter foci of diffusion and T2 signal abnormality which are nonspecific but likely represent bihemispheric subacute small vessel ischemia.2.Additional nonspecific punctate foci of increased T2 signal in the centrum semiovale, probably prior small vessel ischemic disease.3. No evidence of venous congestive encephalopathy.4. Poor visualization of the inferior sagittal sinus, likely technical. No evidence of venous infarct or hemorrhage.