65-year-old male with altered mental status and multiple myeloma not having achieved remission. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No definite intracranial mass or mass-effect. The CSF spaces are prominent in keeping with mild generalized parenchymal volume loss. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Mild mucosal thickening is present the frontal sinuses and scattered ethmoid air cells. Paranasal sinuses and mastoid cells are otherwise clear. The bone marrow signal throughout the calvarium, clivus, and upper cervical spine is heterogeneous, presumably related to patient's multiple myeloma. There is diffuse dural thickening, which is likely reactive. Multiple small subcutaneous lesions are seen in the scalp and face.
1. No evidence of definite intracranial disease, intracranial hemorrhage, or acute infarct.2. Heterogeneous bone marrow signal, compatible with diffuse myelomatous involvement.