 MRI Brain:Small areas of T2 hyperintensity and questionable diffusion restriction are seen involving scattered areas of the cortex, including involving the left precentral gyrus and the hand area of the pre and postcentral gyri on the right without significant mass effect. Some of the lesions demonstrate volume loss potentially indicating chronicity. In addition, there are numerous scattered foci of periventricular and subcortical white matter signal abnormalities, some of which very likely represent chronic small vessel ischemic disease and chronic lacunar infarcts. However some of these lesions have a morphology suggestive of a demyelinating process, including lesions involving the corpus callosum. Abnormal increased T2 signal is present in the right mesial temporal lobe, specifically affecting the right parahippocampal gyrus, which is an atypical location for small vessel ischemic disease. In addition, there are small foci of mild restricted diffusion in the bilateral middle cerebellar peduncles without a clear T2 FLAIR correlate. There are scattered areas of susceptibility punctate foci of susceptibility included within the right thalamus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. The right globe has abnormal signal which may be related to prior hemorrhage or ophthalmologic treatment.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. The origins of the vertebral arteries are not well assessed given artifact in this region.
Multiple periventricular lesions are seen, some likely representing small vessel ischemic disease and/or old lacunar infarcts. However, some of the periventricular lesions show a morphology more suggestive of demyelination. In addition, signal abnormality present within the right mesial temporal lobe structures is atypical for small vessel ischemic disease. More superficially, there are scattered lesions involving the cortex, some of which may demonstrate mild diffusion restriction, while others are likely chronic. This is nonspecific and could reflect an ischemic, vasculitic or demyelinating etiology. The possibility of metastases is considered unlikely, but definitive assessment require postcontrast imaging. In addition, there may be some benefit to dedicated spine imaging as the presence of additional lesions may narrow the differential.No significant flow limiting stenosis involving the intracranial and neck vasculature.As seen on the previous head CT, the right globe demonstrates abnormal signal which may represent prior hemorrhage or ophthalmologic treatment.