Memory deterioration and history of breast cancer, evaluate for etiology. There is no evidence of acute ischemia. There are a few punctate foci of susceptibility effect in the bilateral cerebellum and right temporal occipital junction compatible with chronic microhemorrhages which may be related to chronic hypertension and/or amyloid angiopathy. There are extensive confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate to severe chronic small vessel ischemic disease and/or posttreatment-related changes.There is no abnormal parenchymal or leptomeningeal enhancement. There is mild age appropriate global parenchymal volume loss. There is no midline shift or herniation. No hydrocephalus. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening. There is mild mucosal thickening in the bilateral mastoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable.
1. No evidence of intracranial metastatic disease.2. Extensive T2/FLAIR signal abnormality in the periventricular and subcortical white matter which may represent advanced chronic small vessel ischemic disease and/or posttreatment-related changes (given history of chemotherapy).3. Global parenchymal volume loss which appears appropriate for patient's age.