Diagnosis: Unspecified dementia without behavioral disturbanceClinical question: cognitive declineSigns and Symptoms: memory loss, language problems, some behavior The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic type lesion present along the right cerebellar medullary angle cistern which measures 22 x 18 mm in axial dimensions. It follows spinal fluid on all pulse sequences fairly closely. The adjacent nerve roots, right anterior inferior cerebellar artery and right vertebral artery drape around this cyst its superior extent is at the right cerebellopontine angle cistern where it abuts the right nerves VII and VIII.There is partial empty sella present.There is a T2 hyperintense and FLAIR hypointense lesion present in the left basal ganglia associated with some exact effect on the left lateral ventricle suspected represent an old lacunar infarct associated with some susceptibility effect around it.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Findings are compatible with an arachnoid cyst at the right cerebellar medullary angle cistern displacing the adjacent nerve roots and mildly impressing on the brainstem.2.No evidence for acute ischemic cerebral infarction.3.Findings are compatible with an old lacunar infarct involving left basal ganglia and centrum semiovale.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 