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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 centres 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.