 Previously noted restricted diffusion lesions are not seen anymore.Multiple signal voids on Gradient echo images on bilateral hemispheres may indicate petechial hemorrhage, calcification or amyloid angiopathy, no significant interval change since prior exam.On Gad enhanced images, there are diffuse uniform but pachymeningeal enhancement without evident leptomeningeal enhancement. This finding is likely represent benign nature but the differential diagnosis should include intracranial hypotension, postoperative status, lymphoma involvement, pachymeningeal metastasis such as breast cancer. Since the patient's sagittal images do not show evidence of tonsilar herniation and the shape of ventricular system appear to be within normal limits, the chance of intracranial hypotension could be remote.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Diffuse enhancement of pachymeninges, differential diagnosis include intracranial hypotension, postoperative status, lymphoma involvement, pachymeningeal metastasis such as breast cancer.