Presentation
Previous history of trauma (MVA) years ago. Presenting with a vague episode of leg leg numbness. The patient was followed-up due some non specific features on MRI images.
Patient Data
The focus of hyperintensity on T2/FLAIR in the periventricular white matter adjacent of the right temporal horn is again demonstrated with stable appearance. There is no associated contrast enhancement, diffusion restriction or perfusion abnormalities. SWI demonstrates signal loss in keeping with blood products.
The similar and smaller focus of T2/FLAIR hyperintensity in the contralateral temporal lobe and scattered foci in the semiovale centers are also unchanged. There is a focal thinning of the body of the corpus callosum, stable. Hemosiderin staining noted on SWI.
Remainder brain is unremarkable.
Ventricular system and cisternal spaces appear normal.
There is no shift of the midline structures.
Conclusion: Stable appearance. Presence of hemosiderin in both the corpus callosal defect and the right temporal lobe white matter change, especially in the setting of prior head trauma, makes all these lesions almost certainly traumatic. CADASIL seems to be a most unlikely differential in this setting.
Arrows spotting the T2/FLAIR abnormalities and its correspondence with hemosiderin staining foci on SWI.
Case Discussion
This exam was requested for follow up of some subtle T2/FLAIR signal abnormalities in the white matter in both temporal lobes. This protocol using SWI susceptibility sequences spotted hemosiderin staining within these areas and also in the area of abnormal thinning of the body of corpus callosum. In the setting of a head trauma, as was reported in clinical history, these lesions most likely represent traumatic brain sequelae.
This is one of the reasons why susceptibility sequences should be added in MRI trauma protocols.
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