Clinical question: Rule out stroke, inflammation. Signs and symptoms: Right periorbital pain. Pre and post enhanced brain MRI:Negative diffusion weighted series/.Examination demonstrates extensive confluent FLAIR hyperintensity of the periventricular white matter of bilateral cerebral hemispheres and to a lesser degree of the subcortical white matter. Similar signal changes are also present in bilateral basal ganglia and mild to moderate in the pons. Findings demonstrate no susceptibility associated signal changes or abnormal enhancement. Considering patient's stated age of 89 above findings are highly suggestive of advanced chronic nonhemorrhagic small vessel ischemic strokes.There is mild ex vacuo dilatation of lateral ventricles. Caval septum pellucidum anteriorly which is an anatomical variation is noted.The signal intensity of the cerebral cortex remains within normal. Post enhanced images demonstrate no abnormal parenchymal or leptomeningeal enhancement.The signal voids of major intracranial arterial branches are identified and without detectable abnormality. Images through the orbits and including axial fat sat post enhanced series are unremarkable. There is no detectable preseptal periorbital soft tissue abnormality or enhancement. Bilateral cavernous sinuses demonstrate normal pattern of enhancement and unremarkable. Paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.
1.Negative diffusion weighted series.2.Findings highly suggestive of moderate to advanced chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.No detectable abnormal enhancement.4.Unremarkable images through the orbits and without finding to explain patient's presenting clinical symptoms.5.Unremarkable calvarium, paranasal sinuses and mastoid air cells.