Clinical question: Cognitive impairment, rule out vascular issues, NPH, urinary incontinence. Signs and symptoms: As above. Nonenhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrate small foci of flair hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres, right thalamus and bilateral basal ganglia which considering patient's stated age of 83 most likely representing chronic nonhemorrhagic small vessel ischemic strokes a mild degree. The cortical sulci remain within normal size and morphology for age. There is slight prominence of the supratentorial ventricular system which has remained stable since prior exam from 2014 however slightly more pronounced when compared with prior MRI from 2013. In proper clinical setting possibility of NPH should be considered.The fourth ventricle remains within normal size.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.No acute intracranial process.2.Chronic nonhemorrhagic small vessel ischemic strokes of mild-to-moderate degree with mild interval progression since prior MRI exam 2 - 25 - 2014.3.Slight prominence of supratentorial ventricular system is stable since prior exam from 2014 MRI however with interval progression since MRI from 2013. In proper clinical setting the possibility of NPH should be considered. 