 There is encephalomalacia involving the right posterior frontal and anterior parietal lobes including the right pre-and postcentral gyri. There is susceptibility effect compatible with chronic blood products within this region. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is advanced parenchymal volume loss involving the cerebellum and mild volume loss involving the cerebral peduncles and brainstem which may related. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is evidence of prior left frontal craniotomy. Diffuse mild thickening of the calvarium is noted. 12 mm subcutaneous cystic lesion at the level of the left zygomatic arch, possibly sebaceous cyst.MRA HEAD
1. Right frontoparietal encephalomalacia including the pre-and postcentral gyri. There is also evidence of chronic hemorrhage within this region.2. No evidence of acute ischemia, mass, or mass effect.3. Disproportionate volume loss involving the cerebellum which is nonspecific but may be related to anti-epileptic medications and/or chronic alcohol use, for example. There is calvarial thickening which can also be seen with anti-epileptic medications.4. Small subcutaneous cystic lesion at the level of the left zygomatic arch region, possibly sebaceous cyst.5. Intracranial MRA is unremarkable with no evidence of flow-limiting stenosis, dissection, or aneurysm. Please note MRA neck was requested but not obtained as patient refused to proceed further with the studies. As such, evaluation for arterial dissection in the neck was not performed.6. Degenerative changes in the cervical spine with disk osteophyte complexes and uncovertebral hypertrophy from C3-C4 to C6-C7. No high-grade spinal canal stenosis at any level. Neural foraminal narrowing at multiple levels as detailed above. Overall no significant change since MRI cervical spine from 5/7/2013.7. Unchanged trace prominence of the central canal (tiny syrinx) at the C6 level measuring up to 2 mm which can be a normal variant at this level and of uncertain clinical significance. Otherwise, no cord signal abnormality.