Female, 68 years old, with gait problems and history of obstructive hydrocephalus. No restricted diffusion is seen. Subacute infarction within the left precentral gyrus noted on the prior examination has evolved and now demonstrates chronic appearing T2/FLAIR hyperintensity.Multiple additional foci of periventricular T2/FLAIR hyperintensity are seen with ill-defined hyperintensity is also noted in the pons. These findings have not significantly changed from prior. No pathologic parenchymal or extra-axial enhancement is observed. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. A few scattered foci of susceptibility are seen in association with the left precentral stroke compatible with chronic microhemorrhage.The lateral and third ventricles remain disproportionately enlarged relative to the caliber of the sulci. No interval change is seen in the caliber of the ventricular system. On thin section sagittal imaging, there is no obstruction of the cerebral aqueduct. On CSF flow imaging, robust flow is evident through the cerebral aqueduct, fourth ventricle and foramen of Magendie. A mild blush of flow related signal is also seen adjacent to the foramen of Monro. Robust biphasic CSF flow is seen in the basal cisterns surrounding the brainstem.
1.Previously seen left precentral infarct has evolved and now appears chronic.2.Evidence of fairly extensive additional microvascular ischemic disease is seen.3.The lateral and third ventricles remain enlarged relative to the fourth ventricle and the sulci which is concerning for normal pressure hydrocephalus. However, no obvious obstructive lesion is seen.