 Brain: There is a punctate focus of diffusion restriction, susceptibility effect, and T1 hyperintensity within the right superior frontal gyrus anteriorly and an additional similar punctate focus within the left frontal operculum. There is extensive confluent T2 hyperintensity throughout the supratentorial white matter compatible with chronic small vessel ischemic disease as well as numerous chronic lacunar infarcts both supratentorially and infratentorially similar to prior allowing for differences in technique with the current scan obtained on the 3 Tesla and prior on 1.5 Tesla magnet. There is severe global volume loss. Focal areas of encephalomalacia are again noted in the right cerebellar hemisphere. There are also numerable punctate foci of susceptibility effect supratentorial and infratentorially, both within the subcortical and deep white matter as well as the deep gray nuclei. These have also progressed since the 2012 MRI. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. Cervical Spine:Vertebral body heights in the cervical spine are normal. There is reversal of cervical lordosis centered at the C3-C4 level. Alignment is otherwise maintained. Craniocervical junction is within normal limits.The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine with multilevel loss of intervertebral disc space particularly at C3-C4, C4-C5, and C5-C6. Small disc osteophyte complexes. Mild thickening of the posterior longitudinal ligament from C3-C4 to C4-C5. Individual levels as below:C2-C3: No significant disc disease. No spinal canal or neural foraminal stenosis.C3-4: Small disc osteophyte complex and effacement of the ventral thecal sac. No significant spinal canal stenosis. Uncovertebral hypertrophy with minimal right greater than left neural foraminal stenosis.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy. There is mild left neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis.C5-6: No significant spinal canal stenosis. There is uncovertebral hypertrophy with mild bilateral neural foraminal narrowing.C6-7: There is uncovertebral hypertrophy with mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: There is bilateral uncovertebral hypertrophy and small foraminal disc protrusion on the left. There is mild bilateral neural foraminal stenosis.Visualized extraspinal soft tissue structures are unremarkable.
1.Two punctate foci of subacute hemorrhage within the right superior frontal gyrus and within the left frontal operculum superimposed upon interval progression of innumerable chronic microhemorrhages. Majority of these chronic microhemorrhages involve the bilateral thalami, basal ganglia, brainstem and cerebellum, favoring a chronic hypertensive etiology. 2.Extensive global volume loss including the brain stem, advanced chronic small vessel ischemic disease, and numerous supratentorial and infratentorial chronic lacunar infarcts appear similar since to 2012 MRI.3.Mild degenerative changes in the cervical spine without significant spinal canal stenosis at any level. No abnormal cord signal. Mild multilevel neural foraminal narrowing, as detailed above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.