59 years, Male, dystonia, unspecified. Parkinson's disease.. Limited sequences of the brain were obtained for operative planning. There is slitlike encephalomalacia involving the left posterior subinsular region with rim of T2 hypointensity and susceptibility effect most compatible with chronic hemorrhage. There are also punctate foci of susceptibility effect in the left thalamus as well as the left aspect of the pons compatible with chronic microhemorrhages. There is also a focus of susceptibility in the right putamen. Additionally there is a focus of susceptibility effect in the right anterior frontal lobe just deep to the cortex. Patchy areas of T2 hyperintensity in the bilateral periventricular and subcortical white matter are nonspecific but compatible with chronic small vessel ischemic disease. No abnormal enhancing lesions are evident. No intracranial mass, mass effect, midline shift, or herniation. No hydrocephalus. Major vascular structures are patent. There is minimal paranasal sinus mucosal thickening as well as a small right maxillary mucus retention cyst. Calvarium and extracranial soft tissue structures are otherwise grossly unremarkable.
1. Examination for operative planning. No intracranial mass or abnormal enhancing lesions.2. Chronic hemorrhage involving the left subinsular region. There are additional foci of chronic microhemorrhage particularly in the left thalamus and left pons. Distribution of these findings favors a chronic hypertensive etiology.