Clinical question: Language disorder. Signs and symptoms: Progressive aphasia-PPA with the speech apraxia. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate mild primarily periventricular and to a lesser degree subcortical FLAIR hyperintensity (left greater than right) of bilateral hemispheric white matter and with normal signal intensity of brain parenchyma otherwise. There is mild enlargement of supratentorial ventricular system (left greater than right) with maintained midline which could represent ex vacuo dilatation. There is suggestion of mild interval progression of periventricular white matter findings however with disproportionate interval increased size of supratentorial ventricular system since prior exam. Largest transverse axis of the third ventricle measures at 12.5 mm compared to prior study measurement of 9.5 mm, the combined transverse measurement of the lateral ventricles at 40 mm compared to prior study measurements of 32 millimeter.Generalized prominence of cortical sulci more conspicuous in parietal lobes also with suggestion of interval progression since prior exam and concerning for parenchymal volume loss.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses remain within normal.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.
1.No acute intracranial process.2.Subtle FLAIR hyperintensity only in the periventricular and minimally in the subcortical white matter of cerebral hemispheres with suggestion of mild interval progression since prior exam as detailed. Unremarkable signal intensity of brain parenchyma otherwise.3.Interval increased size of supratentorial ventricular system and highly suspected progression of generalized prominence of cortical sulci (more conspicuous in parietal lobes) since prior study as measured above.