Presented with confabulations. History of alcohol abuse. The patient was sedated with irregular breathing and movement during the examination. The exam was not completed as the patient become combative. There are no axial T1 and diffusion weighted images.There are a few punctate subcortical and mild periventricular cerebral white-matter T2/FLAIR hyperintensities. Accounting for coaptation involving the anterior aspect of the right lateral ventricle, the ventricles and the other CSF-containing spaces are globally enlarged reflecting moderate cerebral and cerebellar volume loss. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved. There is no intracranial hemorrhage.There is trace maxillary mucosal thickening. The other paranasal sinuses are clear. There is also trace T2-hyperintensity within the mastoid air cells.T2-hyperintensity along the nasopharyngeal vault which may represent secretions but is not completely assessed. The clivus shows near complete loss of the expected fatty signal with prominent somewhat geographic appearing T1 hypointensity, with sparing of its lower part. The floor of the sella appears to be maintained. Similar loss of marrow fatty signal is present in the included cervical spine. The calvarial marrow has a more normal appearance. These findings may reflect hypercellular marrow due to chronic medical illnesses but the geographic involvement in the clivus is atypical.
1.Incomplete, limited examination.2.Moderate generalized brain volume loss. Mild cerebral white-matter signal abnormality, probably reflective of microvascular ischemia.3.Loss of the normal fatty signal in the clivus and included upper cervical spine may reflect red marrow reconversion or infiltration in the absence of primary malignancy, although the geographic pattern of involvement in the clivus is atypical. Head CT scan may better characterize the clival abnormality.