Gait instability. Remote history of right caudate infarct (in 2009). There is focal encephalomalacia involving the right frontal coronal radiata as well as the lateral aspect of the right caudate head and the anterior part of the right external capsule, which is unchanged since previous CT scan. Lacunar infarct involving the posterior aspect of the left caudate head is not definitively seen on prior CT. There are also scattered foci of T2-hyperintensity in the cerebral white-matter which are nonspecific but most compatible with chronic small vessel ischemia. There is tiny focus of susceptibility effect in the central superior aspect of the pons without associated edema, which likely represents chronic microhemorrhage. There is no acute infarct or acute intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. There is no abnormal intracranial contrast enhancement.The lateral and third ventricles are moderately dilated, which has mildly increased compared to the previous CT scan. There is also focal dilatation involving some of the sulci.There is minimal ethmoid mucosal thickening. The orbits are grossly unremarkable. There is no destructive skull lesion. Sella turcica is partially empty which is usually normal variant in this age group.
1.There is no acute infarct or intracranial mass. 2.Mild to moderate chronic small vessel ischemic disease with small chronic infarcts as described above. 3.Suggestion of mild disproportionate enlargement of the ventricles compared to the degree of volume loss. Finding may represent communicating hydrocephalus/NPH in the appropriate clinical setting.