Severe headaches with semiology consistent with migraine with aura and suspicion of autoimmune disease: bilateral nystagmus and peripheral neuropathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several, at least 15, punctate foci of high T2 signal in the white matter of the bilateral frontal lobes, which may have progressed slightly since 2011. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter left posterior nasopharyngeal retention cyst. There are partially imaged postoperative findings in the cervical spine.
Punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter are nonspecific, but may represent sequela of migraine, autoimmune, or chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 