Female, 57 years old, with acute on chronic worsening of headache. Numerous scattered T2 hyperintense lesions are again seen within the subcortical and per ventricular white matter with particular involvement of the periatrial regions, the subinsular white matter, the subcortical white matter of the paramedian superior frontal gyri and the anterior temporal poles. No new lesions are seen. No diffusion restriction or pathologic enhancement is detected.There is no evidence of edema or mass effect. The findings are seen to suggest acute or chronic intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles remain normal in size and morphology. Diffuse prominence of the perivascular spaces as a normal variant.
1.Stable extensive scattered areas of parenchymal signal abnormality are seen. The differential continues to include CADASIL, vasculitis, prior inflammation, or a very atypical presentation of demyelinating disease.2.No definite new or acute intracranial findings are seen to account for the patient's worsening headaches.