Focal left hand dystonia. Asymmetric reflexes. There are multiple punctate T2-hyperintense, non-diffusion restricted foci in the frontoparietal white-matter that are nonspecific but most probably reflect chronic microvascular ischemia. There is no mass effect or space-occupying brain lesion. There is no midline shift. Gray-white differentiation is preserved. There is mild brain volume loss manifested by expansion of the ventricles and CSF-containing spaces above and below the tentorium. There is no intracranial hemorrhage by susceptibility weighted imaging. The intradural right vertebral artery does not show the expected flow-void which may reflect slow flow or thrombosis. Major intracranial vascular flow voids are preserved, otherwise.The mastoid air cells are clear. There is mild mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality. There is incidental finding of torus mandibularis.
1.Brain shows volume loss and cerebral white-matter findings of chronic microvascular ischemia. There is no focal brain abnormality.2.The intradural right vertebral artery does not show the expected flow-void which may reflect slow/decreased flow or thrombosis. However, there is no acute infarct and this is unchanged since the previous cervical spine MRI from October 8, 2015, therefore perhaps a chronic finding.