Diagnosis: Abnormality of gait. Dizziness and giddinessClinical question: Episodes of imbalance, vertigo; evaluate cerebellum MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple punctate foci of signal hypointensity in the left periventricular white matter (one adjacent ot the occipital horn and one adjacent to the body of the lateral ventricle) on susceptibility imaging which most likely represent microhemorrhages.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal . There is encroachment of the right exiting nerve roots due to right facet hypertrophy and uncovertebral osteophytes associated with disk material.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a 13x8mm axial dimension T2 hyperintense and T1 hypointense well circumscribed lesion in the posterior and inferior aspect of the right parotid gland.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries is not readily identified. There is fetal origin of the left PCA. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LVA originates from the aortic arch.
1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related and likely of little clinical significance.2.A couple microhemorrhages in the periventricular white matter in isolation are likely of little clinical significance.3.There is encroachment of the right sided exiting nerve roots at C4-5 due to degenerative changes.4.There is no evidence for carotid or vertebral dissection.5.There is not evidence for intracranial or extracranial cerebrovascular occlusive disease.6.A right parotid gland lesion is present which has a relatively benign appearance. Please correlate with clinical exam. If appropriate follow-up imaging may be helpful. This is an incidental finding.