Dementia. Assess for stroke or atrophy. The brain shows diffuse, fairly symmetric and proportionate expansion of the CSF-containing spaces reflecting mild cerebral and cerebellar volume loss. Volume loss in the mesial temporal lobes is proportionate as well. There is relatively minimal confluent periventricular cerebral white matter T2 hyperintensity that is most pronounced in the frontal and occipital lobes. In addition, there are scattered punctate foci of T2 hyperintensity in the frontal deep white matter. These findings are nonspecific but may reflect microvascular ischemia. There is a 7 mm left cerebellar white matter T1-hypointense, T2 hyperintense focus that may reflect a small chronic infarct. None of the lesions is associated with diffusion restriction. There is no intraparenchymal hemorrhage. Flow voids of the major vessels are preserved.There is a 1.5 cm extraaxial mass based on the right side of the anterior aspect of the falx that is isointense to gray matter on both T1 and T2. This is most suggestive of a falcine meningioma. A smaller 10 mm similar mass is present along the posterior aspect of the cribriform plate is most compatible with olfactory groove meningioma.There is minimal ethmoidal mucosal thickening. The orbits are unremarkable accounting for bilateral eye lens replacement.A 1.5 cm focal expansion of the right frontal bone that is bright on both T1 and T2 with tiny foci of T1/T2 hypointensity is compatible with a hemangioma. Deeply T1/T2 hypointense foci in the scalp near the vertex may represent small calcifications.
1.Global brain volume loss without specific lobar involvement, age-appropriate.2.Relatively mild white matter involvement by chronic microvascular ischemia.3.Left cerebellar nonenhancing lesion may represent a tiny nonacute focal infarct. 4.Incidental small parafalcine and olfactory groove presumed meningiomas, within limitations of this noncontrast exam.