63-year-old man with a history of CVA and intermittent left frontotemporal headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is confluent increased FLAIR signal in the periventricular and patchy areas in the subcortical white matter, bilateral basal ganglia and bilateral thalami. The sulci are prominent and there is ex vacuo dilatation of the ventricles. The brain parenchyma and pituitary gland appear unremarkable, and there are no areas of abnormal parenchymal enhancement. There is no midline shift or herniation. No areas of susceptibility artifact are present to suggest prior hemorrhage. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Moderate to advanced chronic small vessel ischemic disease 3.Global volume loss greater than expected for age. 