49 years, Female, increasing headaches and confusion, evaluate for CNS lupus. Compared to 10/17/2011, there has been mild interval increase in patchy areas and scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter. In particular, there is a new patchy area of T2/FLAIR hyperintensity in the left posterior frontal corona radiata. No large vascular territory infarcts are evident. There is T1 hyperintensity involving the bilateral basal ganglia which is nonspecific.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. There is mild volume loss which appears slightly advanced for age. Bone marrow signal is heterogeneous without destructive lesions. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Compared to 10/17/2011, there has been some interval progression of multiple patchy areas and scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter. These are nonspecific but given history may represent chronic small vessel ischemic disease related to lupus-related vasculopathy. No large territory infarcts are evident. No evidence of acute infarct or abnormal enhancement to suggest an active inflammatory process.2. T1 hyperintensity in the bilateral basal ganglia which while nonspecific has been reported with CNS lupus.