Reason: evaluate brainstem chronic infarct History: vertigo No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Nonspecific scattered subcortical white matter FLAIR hyperintensities. These lesions are not seen in the brainstem or posterior fossa. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.
Nonspecific scattered subcortical white matter FLAIR hyperintensities. These are most likely related to chronic small vessel ischemic disease. The differential diagnoses would most likely include migraine sequelae or past axonal injury. Given the lesion locations and appearance demyelination is considered unlikely.