Parkinsonism and cognitive issues. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is blurring of the susceptibility effect in the substantia nigrosomes bilaterally, with loss of the "swallow tail sign". There are a few scattered punctate foci of T2 hyperintensity int eh cerebral white matter. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal in the mastoid air cells, which may represent an effusion.
1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Blurring of the susceptibility effect in the substantia nigrosomes bilaterally can be a manifestation of Parkinson's disease. 