Intractable headache, acute; onset January 1, 2016. History of ALL, status post intrathecal methotrexate, in clinical remission off therapy. The extensive confluent white matter T2 hyperintensity has diminished since 2012, with a higher proportion of residual abnormality in the bilateral parietal lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small right superior frontal sulcus region developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
The extensive confluent white matter abnormality likely related to treatment effects has diminished since 2012, with a higher proportion of residual abnormality in the bilateral parietal lobes. No evidence of intracranial hemorrhage, mass, or acute infarct. 