Unspecified persistent mental disorders. Worsening cognition and gaitSigns and Symptoms: history of shunt for possible NPH 15 years ago, now cognitive decline MRI of the brainNo diffusion weighted abnormalities are appreciated.A ventriculostomy tube courses through the right frontal lobe into the right lateral ventricle with tip in the body of the right lateral ventricle. There is signal change surrounding the ventriculostomy tube with high signal on T2 and FLAIR MRI.. The signal changes associated with the ventriculostomy tube have increased compared to the prior exam from 2003. The tube is in stable position compared to the prior exam. Biventricular diameter on coronal imaging at the level of the ventriculostomy tube entry point is currently 36 mm and previously was 31 mm.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional small lesions which are hyperintense on T2 and FLAIR are present in the brainstem and thalami and basal ganglia and internal capsules. These lesions appear to not have substantially changed compared to the previous exams.On susceptibility imaging a punctate lesion is present in the medial aspect of the thalamus at the tip of the ventriculostomy tube. This probably represents a microhemorrhage which is only seen on susceptibility imaging.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 left vertebral artery is larger than the right vertebral artery.The visualized portions of the paranasal sinuses demonstrate minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.Since the prior exam the lateral ventricles have mildly enlarged. One possibility is that this is a result of atrophy. 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. They appear relatively stable over the past 12 years.3.Lesions in the brainstem thalami and basal ganglia are also likely vascular related. They appear relatively stable over the past 12 years.4.Status post ventriculostomy tube placement. Associated signal change appears to have mildly progressed compared to prior exam. Etiology is uncertain