 BRAIN: Interval progression of numerous oval and punctate T2/FLAIR signal hyperintensities in the periventricular and subcortical white matter, some of which are oriented perpendicular to long axis of the lateral ventricles. There is also prominent T2 hyperintensity within the globus pallidus bilaterally, which may represent chronic small vessel ischemic changes. There are no masses, mass effect or midline shift. There has been interval progression of mild prominence of the ventricles and sulci, consistent with age-related volume loss. There is no evidence for intracranial hemorrhage or diffusion restriction to suggest acute ischemia.The cerebellar tonsils are in normal position. Flow voids are present within the major vessels indicating patency. Again noted is a prominent rounded flow void associated with a known ACOM aneurysm which is grossly similar in configuration but incompletely evaluated. There is no abnormal enhancement within the brain. Lack of dedicated cranial nerve imaging limits evaluation of the abducens nerve. ORBITS:The globes are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated.
1.No acute intracranial abnormality. Significant interval progression of white matter lesions which are nonspecific, with a differential diagnosis including chronic small vessel ischemic changes, demyelinating disease, as well as infectious/inflammatory etiologies. Please correlate clinically.2.No abnormality involving the orbits.3.Incomplete evaluation of known ACOM aneurysm, with grossly similar configuration.