Clinical question: 73-year-old female with memory loss in the last 6 months. History of hypertension, diabetes, intubation in fall. Evaluate for CVA, mass or others. Signs and symptoms: Memory loss. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Examination demonstrates few tiny foci of FLAIR hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Findings are nonspecific and demonstrate no evidence of hemorrhagic changes or abnormal enhancement. Considering patient's age findings likely representing chronic minimal microvascular ischemic changes.There is slight prominence of cortical sulci and mild prominence of lateral ventricles which could still be within normal range for patient's stated age of 73. The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal angles with normal pattern of enhancement.Post enhanced images demonstrate no detectable abnormal parenchymal, meningeal or calvarial enhancement.Paranasal sinuses demonstrate partial opacification of left frontal sinus with mucosal enhancement suggestive of sinus disease. The rest of paranasal sinuses and bilateral mastoid air cells are unremarkable.
1.No acute intracranial process and negative diffusion-weighted images.2.Few tiny foci of FLAIR hyperintensity only in the subcortical and periventricular white matter could represent minute chronic small vessel ischemic strokes.3.Mild prominence of cerebral cortical sulci and supratentorial ventricular system which could be still within normal for patient's stated age of 73.4.No abnormal parenchymal, leptomeningeal or calvarial/retro-orbital enhancement.