69 years, Male, memory loss, evaluate for structural lesions. History of prostate cancer. Examination is slightly limited due to motion degradation. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Relatively more prominent T2/FLAIR hyperintensity is evident involving the left frontal corona radiata. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Incidentally seen is a 3 x 7 mm pineal cyst. No suspicious masses or evidence of intracranial mass effect. Partially empty sella is incidentally noted, which can be normal variant. There is mild to moderate global parenchymal volume loss. There is questionable mild disproportionate enlargement of the ventricular system for the degree of volume loss. No definite evidence of hydrocephalus however. No disproportional volume loss involving the hippocampi is appreciated. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease.There is evidence of prior endoscopic sinus surgery including bilateral uncinectomies and ethmoidectomies. There is moderate opacification of the bilateral frontal sinuses and left greater than right ethmoid sinuses. There is also mild mucosal thickening involving the maxillary sinuses, left greater than right. No destructive lesions involving the calvarium.
1. Mild chronic small vessel ischemic disease.2. Mild to moderate global parenchymal volume loss.3. No suspicious intracranial masses or evidence of intracranial mass effect. No evidence of intracranial metastatic disease.4. Ventriculomegaly is at least predominantly related to the volume loss. There is questionable mild disproportionate enlargement of the ventricular system for the degree of volume loss, which can be correlated for clinical signs of communicating hydrocephalus/NPH.5. Paranasal sinus disease as described above.