Reason: r/o acute process History: ongoing severe headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction appreciated within the brain parenchyma.On susceptibility imaging there are punctate foci of signal hyperintensity in the subcortical white matter of the temporal and occipital lobes as well as the left and right cerebral peduncles and in the thalami. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal 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.Incidental note is made of a developmental venous anomaly in the right cerebellar hemisphereThe 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. There is mild asymmetric signal hyperintensity within the posterior chamber of the right eye versus the left.
1.There is no evidence for acute ischemic infarction.2.Multiple microhemorrhages and are present in the brain parenchyma predominately in the subcortical pattern but involving the deep structures. This pattern is nonspecific.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Asymmetric signal in the right eye posterior chamber versus the left is nonspecific. Because it is only seen on one pulse sequence it may be artifactual, however, correlation to clinical history and exam may help further assess this.