64-year-old male patient with altered mental status, increased frequency of seizures. Suspect meningeal enhancement.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is ventricular enlargement predominately affecting the temporal and occipital horns bilaterally. There is also global parenchymal atrophy. There is a diminished appearance of the right frontal horn, though no discrete mass. There is inferior cerebellar vermian hypoplasia with resulting increase in size of the fourth ventricle and retrocerebellar space. Additionally, there is cerebellar atrophy out of proportion to the supratentorial brain. Abnormal periventricular T2 signal likely represent small vessel ischemic disease. Incidental note of a cavum of septum pellucidum. There is hippocampal volume loss bilaterally, left greater than right, with loss of the internal architecture and increased T2 signal within the left hippocampus. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.There are degenerative changes of the upper cervical spine causing significant canal stenosis at the level of C2 and below.
1. Moderate global parenchymal atrophy without evidence of mass or abnormal enhancement.2. Left greater than right hippocampal volume loss with loss of internal architecture and T2 hyperintensity involving the left hippocampus consistent with left mesial temporal sclerosis.3. Inferior cerebellar vermian hypoplasia.4. Degenerative changes of the imaged cervical spine with severe canal stenosis; if there are clinical symptoms referable to this finding, additional dedicated cervical spine imaging with MRI may be considered.