77-year-old maleDiagnosis: Ataxia, unspecifiedClinical question: h/o cerebellar ataxiaSigns and Symptoms: preop planning for DBS The CSF spaces are appropriate for the patient's stated age with no midline shift. Redemonstrated is a mild degree of periventricular and subcortical hyperintense white matter lesions present identified on the T2 images. A high signal focus on T2 imaging is present in the pons. No abnormal mass lesions or foci of abnormal enhancement are appreciated intracranially. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid and left 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 right vertebral artery demonstrates a small focus of signal within the flow void which is also apparent as a filling defect on enhanced technique within the cisternal portion at the level of the foramen magnum. Mucosal thickening is again noted within a posterior right ethmoid air cell. The remaining visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities, unchanged. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.Stable white matter changes of a mild degree are nonspecific, most likely vascular related, unchanged in appearance. 2.The right vertebral artery demonstrates a small focus of signal within the flow void which is also apparent as a filling defect on enhanced technique within the cisternal portion at the level of the foramen magnum. This may represent focal plaque or residua from prior occlusion. The T2 appearance is unchanged.