Clinical question: Memory deterioration; evaluate for CNS disease. Signs and symptoms: As above. Pre-and post enhanced brain MRI:No acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrates prominence of cerebral cortical sulci which are more prominent in bilateral parietal lobes. There is no associated signal abnormality.There are small patchy foci of flair hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the right thalamus and bilateral basal ganglia. Findings considering patient's stated age of 88 are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.There is normal appearing ventricular system and with maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Minimal patchy opacification of bilateral mastoid air cells and unremarkable paranasal sinuses with the exception of mild left maxillary and coastal thickening.Post enhanced images are unremarkable and demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges, calvarium or retro-orbital spaces.
1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Slight prominence of cortical sulci primarily in the bilateral parietal lobes which likely still within normal range for patient stated age of 88.4.No detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium.