70 years, Male, vision loss out of proportion to exam. Evaluate for CNS pathology including optic nerves, chiasm. Vision loss left greater than right eye. Brain: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. There is a punctate focus of susceptibility in the left temporal white matter as well as in the the right anterior pons/midbrain junction consistent with chronic microhemorrhages and are nonspecific in distribution. There are patchy areas of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease. Multiple lacunar infarcts are evident involving the posterior right frontal centrum semiovale and corona radiata as well as the right thalamus. No hydrocephalus. No extra-axial collections. There is mild global parenchymal volume loss. Sella is grossly unremarkable. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are grossly clear. No lesions involving the calvarium.Orbits: There is no mass within the bilateral orbits. No lesion involving the orbital apices, cavernous sinuses, parasellar region, or optic chiasm. There is motion degradation on multiple sequences which limits assessment of signal abnormality involving the optic nerves. There is question of volume loss involving the bilateral optic nerves.
1. There is no evidence of intracranial mass or mass effect. Note examination is limited to noncontrast sequences due to patient's severe renal insufficiency and is also motion degraded. 2. Examination quality is inadequate for assessment for optic nerve signal abnormality. There is however no intraorbital mass or mass effect on the optic nerves or chiasm. There is suggestion of volume loss involving the bilateral optic nerves.3. Chronic small vessel ischemic disease with multiple lacunar infarcts as described above. There are also two small foci of chronic microhemorrhage in a nonspecific distribution.