Male, 52 years old, with left gaze preference, left upper extremity and left lower extremity weakness. A 13 x 7 mm area of T2 hypointensity and T1 isointensity is demonstrated within the right occipital lobe immediately adjacent to the posterior aspect of the right ventricular atrium. There is no significant associated restricted diffusion at this or any other location in the brain. This lesion is, however, associated with mild susceptibility artifact, and the surrounding parenchyma is edematous with mild local mass effect.Elsewhere in the brain, patchy bilateral periventricular T2 hyperintensity is seen, in addition to scattered cortical and subcortical foci of T2 hyperintensity involving predominantly the left frontal and temporal lobes. A few scattered punctate foci of susceptibility are demonstrated compatible with chronic microhemorrhage. Small lacunar strokes are also demonstrated within the basal ganglia. The ventricular system is within normal limits for size and morphology.
A lesion is demonstrated within the right occipital lobe, immediately adjacent to the posterior margin of the ventricular atrium, with signal characteristics suggestive of deoxyhemoglobin, with mineralization a less likely but still possible consideration. This lesion induces modest local edema.Given the MRI characteristics, and upon review of prior imaging studies, the possibility of an underlying vascular malformation should be considered. The possibility of an underlying tumor also cannot be excluded. Further evaluation with postcontrast MRI imaging, and conventional angiography, would be helpful in making this distinction. 