 There are scattered punctate foci of T2 hyperintensity in supratentorial white matter, primarily in subcortical white matter locations, without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions within the posterior fossa. There is a small area of T2 hyperintensity involving the medial-most aspect of the right caudate head with associated focal ex vacuo dilatation of the lateral wall of the right lateral ventricle. Overall lateral ventricular asymmetry is the within acceptable limits of anatomic variation. There are no findings of hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.
1.There are scattered punctate foci of T2 hyperintensity in supratentorial white matter, primarily in subcortical white matter locations. Lesional morphology, locations, and distributions are not typical for migraine sequela, residua from prior trauma, or demyelination. Thus, this most likely represents mild chronic small vessel ischemic disease.2.There is a small focal area of gliosis and encephalomalacia involving the medial-most aspect of the right caudate head.