Diagnosis: Syncope and collapseClinical question: s/p SAH and contusionSigns and Symptoms: fu s/p SAH and contusion The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions present in the basal ganglia, thalami and brainstem.There are punctate foci of signal loss on susceptibility imaging present along the subcortical white matter of the parietal lobes bilaterally as well as the thalami, brainstem and deep gray nuclei of the cerebellum.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. There is nasal septum deviation towards the left. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Periventricular and subcortical white matter lesions of a moderate degree as well as punctate lesions along the brainstem thalami and basal ganglia are nonspecific. At this age they are most likely vascular related. 2.Multiple microhemorrhages are present in the parietal lobes, brainstem, thalami and cerebellum. This does not establish a clear pattern. This could represent a combination of hypertensive microhemorrhages. The possibility of amyloid angiopathy is also raised.