Female, 86 years old, altered mental status after right hip surgery, concern for ischemia. MRI:Two punctate foci of high signal on diffusion weighted images are seen within the right corona radiata. These show corresponding FLAIR hyperintensity, but no definite ADC correlation.Otherwise, no restricted diffusion is seen. Scattered small foci of T2 hyperintensity are seen within the periventricular white matter. No parenchymal edema or mass effect is detected. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are within normal limits for size and morphology.On postcontrast images, a 2-mm focus of enhancement is seen along the cortex of the lower left parietal lobe (image 3 series 19). No other pathologic parenchymal or extra-axial enhancement is detected.MRA:Aortic branching is conventional. The origins of the great vessels are patent. No significant stenosis is seen within the carotid vasculature of the neck (by NASCET criteria). Likewise, no significant stenosis is seen within the vertebral vasculature of the neck.Intracranially, no evidence of high-grade vascular stenosis or occlusion is seen. No aneurysms are detected within the limitations of technique.
1. No definite acute ischemia. Two punctate foci of hyperintense diffusion signal within the right corona radiata could represent small resolving ischemic lesions or T2 shine through artifact.2. Relatively mild chronic microvascular ischemic disease.3. A single 2-mm focus of enhancement is seen within the lower left parietal cortex, a finding which is of uncertain etiology and significance. However, given the history of multiple prior cancers, a follow up examination should be performed to assess for the possibility of metastatic disease.