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Represented within the frontal and parietal lobe white matter bilaterally, in a fairly symmetrical distribution, numerous well circumscribed and irregularly marginated zones of T2 hyperintense signal are appreciated extending well up to the vertex, many being distributed within the watershed distribution of the frontal lobes bilaterally, and also at the capsular margins. Overall findings are well in keeping with areas of old subcortical and deep white matter infarcts/leuko-encephalopathy. None of these lesions demonstrate restricted diffusion on DWI sequence. No true periventricular white matter signal change is seen. No posterior fossa abnormality is seen. Sulcal, cistern and ventricular anatomy of the anterior and posterior circulation throughout. The right vertebral artery is dominant with normal junction point being demonstrated. Normal calibre of the basilar artery seen. The carotid syphons are normal bilaterally and no supraclinoid disease is seen. There is no evidence of AVM or aneurism.
Conclusion: The findings are well in keeping with a diagnosis of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). No acute infarct is seen on this occasion.