Reason: Evaluate for ischemia, gait instability to L History: Gait instability to L, disorientation, suspected NPH The lateral ventricles and third ventricle and to lesser degree fourth ventricle are large. This was also the case in December. Biventricular diameter on the current exam is 55 mm and was the same in a comparable location on the prior exam. Third vebtricular diameter is currently 16 mm and previously was the same. Temporal horns remian enlarged.Although there is a punctate hyperintense lesion on the diffusion weighted images in the right centrum semiovale there is no associated diffusion restriction on ADC map. Rather there is T2 shine through.On susceptibility imaging there is a punctate focus of signal hypointensity identified in the left frontal lobe appeared in isolation is probably of little clinical significance. It is unchanged when compared to the previous examThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The ventricles are large. This is nonspecific finding. One possibility is that this represents normal pressure hydrocephalus. Please correlate with patient's clinical symptoms.2.There are periventricular white matter lesions present many which are perpendicularly oriented to the lateral ventricle. These are nonspecific. Differential considerations include vascular related lesions as well as demyelination and vasculitis.3.There are periventricular white matter lesions present many which are perpendicularly oriented to the lateral ventricle. These are nonspecific. Differential considerations include vascular related lesions as well as demyelination and vasculitis.