Clinical question: Assess for artifact. Lesion/tumor or other causes of anosmia. Signs and symptoms: Anosmia for 6 months. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates no detectable abnormality of the skull base, bilateral frontal regions or the olfactory bulbs. Very minimal opacification of right ethmoid air cells is noted suggestive of minute sinusitis and unremarkable other paranasal sinuses.There is a focus of encephalomalacia in the right occipital and medial aspect of right temporal lobe posteriorly as well as a tiny focus in the right thalamus all suggestive of small foci of ischemic stroke in the distribution of right PCA.There is normal anatomic cord morphology of the brain parenchyma and with normal signal intensity on all MRI sequences otherwise.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of all major intracranial arterial branches are identified.Post contrast images demonstrate no abnormal parenchymal, leptomeningeal or calvarial enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of intracranial venous sinuses with normal pattern of enhancement.
1.No diffusion-weighted abnormality.2.No evidence of pathology to explain patient's anosmia. Unremarkable calvarium and skull base.3.Foci of FLAIR hyperintensity in the right occipital, medial aspect of right posterior temporal and right thalamus suggestive of chronic ischemic changes of PCA territory.4.Unremarkable pre and post enhanced brain MRI otherwise and without abnormal enhancement.5.Minute right ethmoid sinus disease and unremarkable paranasal sinuses otherwise.6.Images through the nasal passage demonstrate moderate leftward nasal septum deviation.