86 years, Male, memory and language decline, assess for lobar atrophy. Word finding difficulty, poor word generation, and difficulty with repetition.. There is global parenchymal volume loss without a clear lobar distribution, but perhaps affecting minimally more the frontal and parietal lobes and not significantly changed since prior study from 12/16/2009. No disproportional volume loss involving the hippocampi. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease and minimally progressed since prior. There is a focus of volume loss in the right cerebellar hemisphere compatible with a small chronic infarct but new since prior study dated 12/16/2009. No evidence of acute ischemia. No evidence of hemorrhage. No intracranial mass or mass-effect. There is ossification along the falx which is within normal limits. No hydrocephalus. No extra-axial collections. Mild scattered opacification is evident in the paranasal sinuses.
1. Global parenchymal volume loss without a particular lobar distribution and not significantly changed since prior from 12/16/2009. No intracranial mass or mass effect.2. Mild to moderate chronic small vessel ischemic disease which is minimally worse since prior. There is also a small right cerebellar infarct which appears chronic but is new since prior.