Insidious dementia. There is moderate diffuse cerebral white matter T2 hyperintensity bilaterally, predominantly in a periventricular distribution. There is a subcentimeter area of encephalomalacia in the right cerebellar hemisphere. There is no evidence of intracranial mass or acute infarct. There is no abnormal intracranial enhancement. There is a punctate focus of susceptibility effect in the left pons, which may represent a chronic microhemorrhage. There is prominence of the lateral and third ventricles, perhaps out of proportion to the other cerebrospinal fluid spaces. 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. Prominence of the lateral and third ventricles, perhaps out of proportion to the other cerebrospinal fluid spaces, may indicate normal pressure hydrocephalus. 2. Moderate chronic small vessel ischemic white matter disease and a chronic right cerebellar lacunar infarct, but no acute infarct. 