75 years, Female, multiple myeloma and breast cancer, carries diagnosis of vasovagal syncope, presenting today after spell concerning for epileptic seizure. There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small ischemic disease. Small probable chronic lacunar infarct involving the right right frontal corona radiata and anterior aspect of the caudate body; prominent perivascular space remains an alternative possibility. No hydrocephalus. No extra-axial collections. No evidence of acute ischemia or hemorrhage. Bilateral hippocampi are symmetric in size and signal characteristics with grossly preserved internal architecture; no findings to suggest mesial temporal sclerosis. Major flow-voids are preserved. Pituitary gland is slightly prominent in size for age which is nonspecific. There is heterogeneous marrow signal which may be related to known multiple myeloma. There are however no discrete destructive osseous lesions demonstrated.
1. No evidence of intracranial metastatic disease. No findings to suggest seizure focus are appreciated.2. Mild to moderate chronic small vessel ischemic disease.