Differential Diagnosis

The following differential diagnosis is based on the provided MRI findings:

• Single most likely diagnosis
  • Chronic small vessel ischemic changes: This is the most likely diagnosis given the presence of a focal abnormal hyperintense flare signal in the subcortical matter of the left parietal lobe without associated mass effect or abnormal enhancement. The lack of restricted diffusion and absence of acute hemorrhage also support this diagnosis.
• Other Likely diagnoses
  • Virchow-Robin spaces: These are fluid-filled spaces that can appear as hyperintense signals on MRI and are often seen in the subcortical matter.
  • Perivascular spaces: Similar to Virchow-Robin spaces, perivascular spaces can appear as hyperintense signals and are often benign.
  • Demyelinating disease (e.g., multiple sclerosis): Although less likely, demyelinating diseases can cause hyperintense signals in the subcortical matter.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cavernous malformation: Although the punctate blooming artifacts suggest calcification, it is essential to consider cavernous malformation, which can be life-threatening if ruptured.
  • Arteriovenous malformation (AVM): AVMs can cause abnormal signals on MRI and can be deadly if ruptured.
  • Tumor (e.g., glioma): Although the lack of mass effect and abnormal enhancement makes this less likely, it is crucial to consider the possibility of a tumor, especially if the patient has a history of cancer.
• Rare diagnoses
  • Amyloid angiopathy: This condition can cause microhemorrhages and abnormal signals on MRI, but it is relatively rare.
  • Vasculitis: Inflammatory diseases affecting the blood vessels can cause abnormal signals on MRI, but they are relatively rare and often have other systemic symptoms.
  • MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes): This rare genetic disorder can cause abnormal signals on MRI, but it is often associated with other systemic symptoms and a characteristic clinical presentation.