Headache [R51] / Viral meningitis, unspecified [A87.9], Reason for Study: ^Reason: please r/o structural abnormality vs infiltrate History: Headache There is no evidence of acute ischemic or hemorrhagic lesion.There are ill defined subtle increased a bit patchy confluent signal intensities on bilateral periventricular white matter especially on FLAIR images. Those lesions do not show any evidence of enhancement on Gad infusion. There is no evidence of susceptibility artifact either. These MR findings are non specific but the pattern could represent early CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) although there is no evidence ischemic lesion. On previous scan performed on Feb 25 2011, the FLAIR images also show similar findings. Therefore, considering the different MR scanner and improved signal to noise ration with 3T imager, above findings can be seen as stable lesion. 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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. The left maxillary sinus show retention cyst.
1. Ill defined subtle, a bit confluent and patchy high signal intensity lesions on bilateral periventricular white matter especially on FLAIR images. These lesions are non specific but could represent an early manifestation of white matter disease such as CADASIL as described above. Imaging follow up using MRI can be considered.2. No evidence of acute ischemic or hemorrhagic lesion.3. No abnormal enhancement.