Female, 78 years old, with history of lung cancer complaining of dizziness and unsteady gait. No restricted diffusion is seen. Extensive patchy parenchymal T2 hyperintensity is redemonstrated appearing similar in terms of lesion number and lesion distribution. As before, lesions are evident in the periventricular and subcortical regions as well as the brainstem and deep gray nuclei. However, lesions are also noted symmetrically affecting the bilateral frontal convexities and the far anterior temporal lobes. No definite evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. A punctate focus of susceptibility in the right cerebellum is unchanged. No other evidence of acute or chronic hemorrhage is seen. An exostosis off the left occipital bone is unchanged.
There has been no significant interval change in the quantity or distribution of rather extensive T2 hyperintense parenchymal lesions. Although this could represent small vessel ischemic disease, lesion morphology and distribution are somewhat atypical. The possibility of CADASIL or some other arteriopathy or vasculitic process should also be considered.Within the limitations of a noncontrast examination, there is no evidence to suggest any acute parenchymal lesion. No brain metastases are suspected.