1. MRI Brain without contrast—No suspicious parenchymal abnormality. Scattered bilateral periventricular and subcortical white matter punctate foci of high FLAIR and T2 signal, more so than would be anticipated for a patient of this age. Non-specific in appearance and could represent areas of demyelination, trauma, infection, vasculitis, microvascular ischemia, or even sequelae of migraine headache. Addition of gadolinium may be of benefit.
2. MRI Brain with contrast—Case Photo #1White matter foci do not exhibit enhancement and are thought unlikely to represent currently active process.
Neurology consultation— Exercise-induced migraine headaches (benign exertional headaches). Lesions on MRI common in migraine headaches (referred to as “migraine freckles”); however, old traumatic brain injury cannot be ruled out.
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