Clinical question: Dementia. Signs and symptoms: Dementia. Nonenhanced brain MRI:No diffusion-weighted abnormalities.There are few punctate nonspecific foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Considering patient's stated age of 77 findings likely representing minute chronic nonhemorrhagic small vessel ischemic strokes.The signal intensity of brain is otherwise within normal on all MRI sequence.There is however diffuse prominence of cortical sulci and supratentorial ventricular system which although could be within upper normal range considering patient's age, possibility of underlying parenchymal volume loss is also of concern. Images through posterior fossa are unremarkable.The signal void of all major intracranial vasculature is identified.Calvarium and scalp are unremarkable.Images through the orbits are unremarkable.Paranasal sinuses and mastoid air cells age well pneumatized.
1.No acute findings.2.Prominence of cortical sulci and the supratentorial ventricles concerning for volume loss. See above comments.3.Findings suggestive of minute chronic nonhemorrhagic small vessel ischemic changes.