Male, 42 years old, with right-sided weakness for one day prior to the ER, resolved by neuro attending evaluation, with visual field defects (inferior nasal defect on the right and inferior scotomata on the left). Assess for ischemic lesions or perfusion deficits. Numerous small foci of T2 hyperintensity are seen, mainly scattered through the cerebral hemispheres where they are predominantly peripheral and subcortical and distinctly not periventricular. There are probably a few lesions within the posterior fossa as well. These findings have not significantly changed.No evidence of any restricted diffusion is seen. No parenchymal edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen.On postcontrast imaging, no pathologic parenchymal or extra-axial enhancement is observed. On perfusion imaging, no convincing deficits or perfusional asymmetries are seen.
1. Redemonstration of numerous small, peripheral foci of white matter signal abnormality. The differential diagnosis for this finding would include sequela of migraine, vasculitis or perhaps some other vascular phenomenon. Inflammatory or demyelinating conditions may also be considered. The distribution of these lesions is not consistent with typical microvascular ischemic disease.2. No evidence of any pathologic parenchymal or extra-axial enhancement is seen. No convincing perfusion abnormalities are seen.