Neurology department's request to consider structural lesions in a patient with global motor awkwardness.
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Bilateral symmetric structures located at the lenticulo-capsular parenchyma that are hyperintense on T2, hypointense on T1 and FLAIR sequences, and without diffusion restriction, with gliotic halo in relation to prominent Virchow-Robin spaces ("status cribrosum" or "état criblé").
Right frontal and left occipital focal lesions visible in SWI consistent with microbleeds or tiny cavernomas.
Tiny hyperintense lesions, some of them confluent, located in subcortical and periventricular white matter consistent with chronic small vessel ischemic lesions.
Diffuse cortical atrophy with prominent ventricular system.
Bilateral symmetric enlarged Virchow Robin spaces in the basal ganglia consistent with état criblé or status cribrosum.
The main differential diagnosis is état lacunaire, which is related to multiple lacunar infarcts that shows a similar appearance.