Clinical question: Vascular versus Alzheimer. Signs and symptoms: Memory loss starting 1.5year ago. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates numerous small narrowing size foci of FLAIR and T2 hyperintensity primarily in the periventricular white matter of cerebral hemispheres as well as bilateral basal ganglia, the sclerosis and minimally in the subcortical white matter of cerebral hemispheres. The findings are consistent with chronic small vessel ischemic strokes which are hemorrhagic in the basal ganglia. The signal intensity of the cerebral cortex, bilateral thalami, pons and cerebellum/vermis remains within normal.The cortical sulci and ventricular system as well as the CSF spaces are within normal and without finding to suggest parenchymal volume loss.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable.Images through the orbits are unremarkable.All paranasal sinuses are visualized and pneumatized however a small retention cyst in the dependent right maxillary sinus is noted.
1.No acute intracranial process.2.Moderate chronic and minimally hemorrhagic small vessel ischemic strokes primarily in the periventricular and bilateral basal ganglia and to a lesser degree in the subcortical white matter as detailed.3.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient's stated age.