Clinical question: Source of headache, history of uterine cancer. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates several punctate foci of nonspecific flair hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres. Although nonspecific in proper clinical setting they could represent minimal chronic small vessel ischemic strokes.The anatomical morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Unremarkable C. cortex, cortical sulci, ventricular system and CSF spaces.Post enhanced images demonstrate no convincing evidence of a study lesion. There is a tiny focus of enhancement superficially in a right posterior frontal sulci which is highly suggestive of representing a vessel. Remote possibility of metastases cannot be however entirely excluded. This finding is best appreciated on axial post enhanced series 1001 image 21 and sagittal reformatted series 1203 image 116. There is no associated signal abnormality at this site on any of the other MRI sequences.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells demonstrate normal signal intensity.
1.Negative diffusion weighted images.2.Findings suggestive of mild chronic small vessel ischemic strokes. 3.No convincing evidence of metastatic disease.4.Punctate superficially located focus of enhancement in right posterior frontal most likely representing a vasculature, however remote possibility of tiny metastases cannot be entirely excluded. Please see above comments.