34 years, Female, history of mechanical mitral valve presenting with TIA/?CVA. Thrombus on the mitral valve on TEE. Monocular blindness. No restricted diffusion to suggest acute ischemia. No intraparenchymal mass or mass-effect. The ventricles are within normal limits in size and configuration. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. There also few scattered foci of susceptibility such as in the left frontal lobe and left temporal lobe deep white matter compatible with chronic microhemorrhages. 5 mm pineal cyst is incidentally noted. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. No evidence of acute infarct.2. Few nonspecific scattered foci of T2/FLAIR hyperintensity in the white matter which may represent mild chronic small vessel ischemic changes, related to prior inflammation, or less likely demyelination. There are also a few nonspecific foci of chronic microhemorrhage.