Reason: cognitive impairment - h/o breast CA History: cognitive decline, behavioral changes The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There also punctate lesions present in the brainstem which are high signal on T2 and flair MRI.No abnormal enhancing 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lens is thin.
1.Periventricular and subcortical white matter changes of a moderate degree and a small lesion in the brainstem are nonspecific. At this age they are most likely vascular related. 2.No abnormal enhancing lesions are identified intracranially to suggest brain metastases