Diagnosis: Unsteadiness on feetClinical question: ?cerebellar deficit or subacute combined deficiencySigns and Symptoms: unsteady gait The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. At this age they're likely of little clinical significance and can be considered age related.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of partial empty sella. Incidental note is made of a developmental venous anomaly in the left superior frontal gyrus.
1.There is no evidence for intracranial mass lesions. Please note that subacute combined degeneration may manifest itself in the cervical spinal cord. Although there is no evidence of that on this exam of the brain, MRI of the cervical spinal cord may be helpful to assess the spinal cord.