 There is no acute infarct, mass effect, or cerebral edema. There is moderate diffuse global volume loss with superimposed diffuse ventriculomegaly which is out of proportion to the degree of sulcal prominence, with the right lateral ventricle larger than the left. There is also volume loss in the brainstem and the cerebellar hemispheres. There are few small foci of susceptibility effect in the brainstem, left anterior temporal lobe, and right frontal and parietal lobes likely representing chronic microhemorrhages, some of which may be subarachnoid in location. There is moderate periventricular and subcortical white matter T2 signal abnormality which is nonspecific, likely representing chronic microvascular ischemic changes, including multiple chronic lacunar infarcts along the thalami and possibly the basal ganglia likely superimposed upon prominent perivascular spaces in the bilateral basal ganglia. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening in the maxillary sinuses.
1.No acute infarct or mass effect.2.Moderate diffuse global volume loss including the brainstem and bilateral cerebellar hemispheres.3.Ventricular prominence may still be slightly out of proportion to the degree of volume loss, please correlate clinically for superimposed normal pressure hydrocephalus.4.Moderate chronic microvascular ischemic changes. Scattered foci of susceptibility likely representing chronic blood products, some of which may be in the subarachnoid space along the brainstem.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.