76-year-old female with new onset weakness. MRI Brain: There is a small amount of layering material in the posterior horn of the left lateral ventricle which demonstrates associated susceptibility artifact, compatible with blood products. There is also a punctate focus of susceptibility in the posterior left thalamus. There are extensive periventricular and subcortical T2 hyperintensities. There are no areas of restricted diffusion to indicate acute infarction. There is mild cerebral parenchymal volume loss. There is asymmetry of the lateral ventricles, left greater than right, which may be related to ex vacuo dilatation secondary to a prior infarct. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.MRI Cervical Spine: There is straightening of the cervical spine, but no spondylolisthesis. The vertebral body height is preserved. The vertebral bone marrow signal is unremarkable. There is multilevel degenerative spondylosis, which is most pronounced at C5-C6 and C6-7, where posterior disc-osteophyte complexes slightly indent the spinal cord and result in mild to moderate neural foraminal stenoses. There is no abnormal spinal cord signal. There is no evidence of abnormal enhancement or mass. The paraspinal soft tissues are unremarkable.
1. Acute hemorrhage within the posterior horn of the left lateral ventricle and focal susceptibility effect in the left posterior thalamus, which may represent a mildly prominent normal vessel, hypertensive hemorrhage, or perhaps a microarteriovenous malformation. Further evaluation with CTA is recommended.2. Mild white matter chronic ischemic disease, but no evidence of acute infarction.3. Degenerative spondylosis of the cervical spine, which is most pronounced at C5-6 and C6-7. 