Female, 62 years old, dizzy and not feeling well status post fall. Numerous punctate foci of T2 hyperintensity are present scattered through the cerebral hemispheres, a non-specific finding. No diffusion restricting lesions are seen. No evidence of edema or mass effect is detected. There are no findings to suggest acute or chronic hemorrhage. The lateral and third ventricles are normal in size and morphology.The cerebellar fissures are prominent, particularly along the vermis and upper cerebellar hemispheres, out of proportion to the cerebral sulci which are relatively normal. In addition, the pons and middle cerebellar peduncles appear subjectively small. The fourth ventricle is prominent.On DTI imaging, no gross diffusional asymmetries or obvious focal loss of anisotropy is detected.Although the temporal bone structures are not specifically evaluated on this study, the right superior semicircular canal may be dehiscent.
Findings are seen suggesting atrophy of the pons, middle cerebellar peduncles, cerebellar vermis and superior cerebellar hemispheres. These features, while not entirely specific, at least raise the possibility of an early manifestation of multiple system atrophy. Other degenerative processes, such as one of the spinocerebellar ataxia conditions, could be considered as well based on clinical symptomatology.No convincing findings of posttraumatic parenchymal injury are seen. Small foci of signal abnormality scattered through the cerebral hemispheres are nonspecific. Most commonly, these lesions reflect chronic microvascular ischemia, though the differential is broad and would include sequelae of prior inflammation, infection, demyelination, or migraine headache among many others.Incidentally noted is the appearance of possible dehiscence of the right superior semicircular canal. If vestibular symptoms are suspected, this potential finding can be better assessed with dedicated temporal bone CT.