 Brain MRI:There are multiple scattered punctate to small foci of T2 hyperintensity within the supratentorial white matter, primarily subcortical white matter in location, without associated restricted diffusion, susceptibility abnormality, or enhancement. There are no posterior fossa lesions. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. A 2 mm base dimension infundibulum is noted of the right posterior communicating artery.
1.There are multiple scattered punctate to small foci of T2 hyperintensity within the supratentorial white matter, primarily subcortical white matter in location, without associated restricted diffusion, susceptibility abnormality, or enhancement and there are no posterior fossa lesions. These are nonspecific in appearance, and for a patient aged 59 years the most likely etiology is chronic small vessel disease. However, the differential diagnosis would also include migraine sequelae or vasculitide. Given lesional morphology and locations, demyelination is felt to be unlikely. 2.A 2 mm base dimension infundibulum is noted of the right posterior communicating artery. Otherwise negative MRI of the brain.