Altered mental status and ataxiaClinical question: r/o stroke, NPHSigns and Symptoms: r/o stroke, AMS ataxia There is a 20x29mm axial dimension cyst in the pineal region compatible with arachnoid cyst. It follows CSF on all pulse sequences. There is associated flattening of the tectal plate.The lateral ventricles are relatively large in relation to the sulci.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is loss of volume along the left middle frontal gyrus associated with medial displacement of the adjacent vasculature.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.
1.Large lateral ventricles. The possibility of normal pressure hydrocephalus cannot be excluded. Another possibility is that this is related to the pineal region arachnoid cyst.2.Pineal region arachnoid cyst associated with flattening of the tectal plate.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for acute ischemic cerebral infarction.5.Focal volume loss along the left middle frontal gyrus is non-specific.