Dizziness, abnormal CT No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is moderate degree of T2/FLAIR hyperintensity involving the right greater than left frontal and parietal subcortical and periventricular white matter. There are focal areas of cystic change in the left frontal and left parietal white matter which may represent small areas of cystic encephalomalacia or prominent perivascular spaces. No large vascular distribution infarcts are evident. Major flow-voids are preserved with incidental note of variant anatomy with occipital sinus on the left. There is mild volume loss involving the left parietal lobe without underlying large infarcts. No abnormal parenchymal or meningeal enhancement.There is slight prominence of the vascularity in the right cerebral hemisphere. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits. There is extensive opacification involving the right maxillary sinus with polypoid soft tissue extending into the right nasal cavity. There is also moderate opacification of the right greater the left frontal and ethmoid sinuses.
1. Extensive areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter in the frontal and parietal lobes. Finding may be related to vasculopathy. Entities such as CADASIL could be considered although the relatively characteristic anterior temporal pole lesions are not present. Demyelinating disease is also in the differential although the morphology and distribution of these lesions is not typical for multiple sclerosis. 2. There is asymmetric volume loss involving the left parietal lobe and apparent relative increased vascularity in the right cerebral hemisphere. These findings may also be related to a chronic vasculopathy. Leukomalacia related to remote perinatal injury is also a possibility. 3. No evidence of acute infarct or intracranial mass effect. No abnormal parenchymal or meningeal enhancement.4. Moderate paranasal sinus opacification as detailed above.