70-year-old female with Parkinsonism, gait and balance issues with falls backwards, evaluate midbrain and cerebellum and ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate to severe periventricular and to a lesser degree subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. No significant change since prior study from 12/27/2013. There is also a small focus of T2 hyperintensity in the right paramedian upper aspect of the pons likely reflecting chronic infarct and present on 5/13/2015 CT but not definitively seen on prior MRI from 2013. There is is moderate degree of global parenchymal volume loss. No disproportional volume loss involving the brainstem or cerebellum is appreciated.There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Moderate to severe periventricular, and to a lesser degree subcortical, white matter T2/FLAIR hyperintensity is nonspecific but likely related to chronic small vessel ischemic disease. Prior inflammation or demyelination are additional considerations. There is also a chronic right pontine lacunar infarct. 2. No disproportional volume loss involving the brainstem or cerebellum. No evidence of hydrocephalus. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.