Clinical question: Memory issues. Signs and symptoms: Memory issues. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrate small foci of flair hyperintensity in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglia and thalami and pons which are nonspecific, nonhemorrhagic and nonenhancing. However considering patient's stated age of 76 this appearance most likely representing microvascular chronic ischemic changes of mild degree.There is a slight prominence of cortical sulci and supratentorial ventricular system which may be still within upper range of normal for age.Post-enhanced images are negative for any abnormal enhancement the brain parenchyma, leptomeninges, peritoneum or the retro-orbital spaces.There is normal signal intensity intracranial venous sinuses and with normal pattern of enhancement.Images through the orbits demonstrate a small chronic right lamina papyracea blowout fracture.Paranasal sinuses demonstrate minimal chronic left maxillary sinusitis. Mastoid air cells demonstrate patchy opacification bilaterally.
1.No diffusion weighted abnormalities and no acute ischemic stroke. 2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.No detectable abnormal enhancement.4.Small right orbital lamina papyracea chronic blowout fracture. 