64-year-old male with confusion, HPV + SCC of right BOT. There are two small foci of restricted diffusion within the left frontal and left posterior temporal lobe with associated T2/FLAIR hyperintensity and punctate enhancement (series 6, images 13 and 15). There are scattered T2/FLAIR hyperintense foci within the subcortical and periventricular white matter with no associated restricted diffusion or enhancement most consistent with chronic small vessel ischemic disease. Additional punctate focus of T2/FLAIR hyperintensity within the left cerebral hemisphere likely represents prior chronic infarct. No acute intracranial hemorrhage. The CSF spaces are appropriate for patient age without mass effect or midline shift.The imaged orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear.
1. Two small foci of restricted diffusion with associated T2/FLAIR hyperintensity and punctate enhancement are nonspecific and could represent small metastases, although small ischemic lesions could potentially also enhance in the subacute phase. Close interval follow-up is recommended. 2. Chronic small vessel ischemic disease within the subcortical and periventricular white matter without evidence of acute ischemic infarction. Focus of T2/FLAIR hyperintensity within the left cerebellar hemisphere likely sequelae of chronic infarct.