Clinical question: Rule out mass. Signs and symptoms: Acute headache. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion-weighted images.Examination redemonstrates diffuse punctate foci of FLAIR hyperintensity in the subcortical white matter of bilateral cerebral hemispheres which are nonspecific and demonstrate no appreciable interval change since prior study. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.Post contrast images demonstrate no abnormal parenchymal or leptomeningeal enhancement.Normal signal intensity of intracranial venous sinuses and the normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium and scalp and without abnormal enhancement.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.
1.No acute intracranial process and negative diffusion weighted series.2.Stable minute punctate and ventricular foci of hyperintensity which is a nonspecific finding.3.Unremarkable pre and post enhanced MRI exam otherwise.4.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.