Altered mental status, evaluation for cerebrovascular accident. Multifocal scattered high signal intensities on FLAIR images especially on deep white matter and periventricular white matter indicate nonspecific small vessel ischemic disease.There is a focal tissue loss with a high signal intensity on FLAIR imaging on the right basal ganglia and bilateral external capsule indicate chronic ischemic lacunar infarcts.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is a well-circumscribed mass lesion on right side anterior to masseter space within subcutaneous fat tissue. The lesion demonstrated restricted diffusion but shows high signal intensity on both T1 and T2 weighted images and the signal intensity is very similar to that of subcutaneous fat. The differential diagnosis include epidermoid, epidermal inclusion cyst or other cystic lesion with high protein content.
1. Non specific small vessel ischemic disease and multifocal chronic lacunar infarctions as described above.2. Well circumscribed cystic lesion (22.9mm x 38mm) with restricted diffusion within the right subcutaneous tissue, differential diagnosis include epidermoid, epidermal inclusion cyst, or other cystic lesion with high protein content.