Clinical question: Evaluate for memory loss. History of on transplant rejection medication (Prograf, prednisone, CellCept), heart and kidney transplant. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates mild to moderate periventricular and subcortical, bilateral basal ganglia and more extensively pontine foci of flair/T2 hyperintensity. Although findings are nonspecific the appearance is highly suggestive of chronic small vessel ischemic strokes.Susceptibility MR images demonstrate extensive supratentorial and infratentorial punctate foci of susceptibility and a single larger focus in the cortex of right posterior frontal lobe which are not visible on any other MR sequences. Findings are highly suggestive of multiple microhemorrhages and raising the possibility of amyloid angiopathy.There is prominence of cortical sulci and mild prominence of lateral ventricles which could be at the upper limits of normal however underlying volume loss is also suspected. The signal void of major intracranial arterial branches are identified.There is no detectable abnormal parenchymal, leptomeningeal or calvarial of enhancement. Unremarkable images through the orbits including axial post-enhanced series. Minimal opacification of left posterior ethmoid air cells and unremarkable paranasal sinuses otherwise
1.Negative diffusion weighted images.2.Findings highly suggestive of small vessel ischemic strokes involving subcortical and periventricular white matter as well as bilateral basal ganglia and extensively of the pons. Numerous foci of susceptibility consistent with microhemorrhages in both supine infratentorial spaces are identified and concerning for amyloid angiopathy. Parenchymal volume loss is suspected.3.No abnormal parenchymal, leptomeningeal or calvarial enhancement.