65 years, Male, ataxia, rule out new ischemic event.. No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. There is extensive encephalomalacia involving the right frontal lobe extending into the right anterior temporal lobe. Minimal encephalomalacia involving the left inferior frontal lobe also noted. There is mild ex vacuo dilatation of the right lateral ventricle. No hydrocephalus. Minimal foci of susceptibility compatible with chronic blood products are noted in the right frontal and anterior temporal lobes. There are foci of T2 hyperintensity with volume loss involving the globi pallidi which may be related to prior ischemic or metabolic injury. Additional scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is cystic change/volume loss involving the left lateral aspect of the cervicomedullary junction compatible with prior injury. There is also mild to moderate generalized volume loss involving the cerebral hemispheres as well as of the cerebellar vermis and hemispheres.Paranasal sinuses are grossly clear. There is minimal opacification involving the bilateral mastoid air cells. Major flow-voids are preserved. There is mild deformity involving the bilateral medial orbital walls with medial herniation of fat and slight contour deformity involving the medial recti muscles which is suspected to be related to remote trauma.
1. No evidence of acute infarct.2. Extensive encephalomalacia in the right frontotemporal lobes favored to be related to prior trauma. Additional foci of signal abnormality and volume loss are seen in the bilateral globi pallidi which may be related to prior ischemic or toxic-metabolic injury. Additional focus of volume loss is seen involving the left lateral medulla/upper cervical cord junction also likely related to remote injury.3. Mild to moderate volume loss involving the cerebellar vermis and hemispheres and to a lesser degree the bilateral cerebral hemispheres. Finding is nonspecific and may be related to antiepileptic medications and/or chronic alcohol use, for example.