Female, 53 years old, with left lower extremity weakness and dizziness. A 5-mm focus of T2 hyperintensity is seen within the centrum semiovale just below the right pre-central gyrus. Although this lesion is bright on the diffusion images, there is no ADC correlate indicating likely T2-shine-through artifact. This lesion produces no mass effect. Approximately three additional punctate T2 hyperintense, non-diffusion restricting lesions are also seen in the periventricular white matter. No pathologic enhancement is seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricular size and morphology are normal.
A 5-mm lesion is seen in the right centrum semiovale, just below the pre-central gyrus. The location of this lesion could potentially account for the patient's left lower extremity weakness. Several additional punctate periventricular lesions are also seen. The differential diagnosis would include demyelinating disease among other inflammatory processes. A vascular etiology such as vasculitis or ischemic disease if felt to be less likely.