 There is an abnormal iron accumulation pattern, specifically demonstrating asymmetric putamen greater than globus pallidus iron. Associated with this is extensive bilateral caudate iron accumulation. There is also T2 hyperintensity just inferior to the tectum and involving the bilateral superior cerebellar peduncles. There are also scattered foci of T2 hyperintensity in the periventricular and subcortical white matter, as well as pons, confluent in some locations, without associated mass effect, restricted diffusion, or susceptibility abnormality. The ventricles and sulci are normal in size, and there is no evidence of preferential cerebellar/pontine atrophy. There is no MRI evident "hot cross bun sign". The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Note is made of degenerative changes of the upper cervical spine including anterolisthesis C3 on C4 with probable central stenoses at C3/4 and C4/5.
1.There is an abnormal iron accumulation pattern, specifically demonstrating asymmetric putamen greater than globus pallidus iron. Associated with this is extensive bilateral caudate iron accumulation. There is also T2 hyperintensity just inferior to the tectum and involving the bilateral superior cerebellar peduncles. There is no evidence of preferential cerebellar/pontine atrophy. The constellation of these features are suggestive of an iron accumulating neurodegenerative disorder.2.Moderate chronic small vessel ischemic disease.3.Note is made of degenerative changes of the upper cervical spine including anterolisthesis C3 on C4 with probable central stenoses at C3/4 and C4/5.