Diagnosis: Unspecified abnormalities of gait and mobilityClinical question: vascular parkinsonism, gait instability MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Some enlarged perivascular spaces are present in the deep gray nuclei and left thalamus.On susceptibility imaging there are punctate subcortical white matter signal hypointense foci present located in the left inferior frontal gyrus, right precentral gyrus, right inferior parietal lobule, left inferior parietal lobule, left posterior temporal lobe, right middle frontal gyrus, periventricular white matter adjacent to the trigone of the right lateral ventricle, adjacent to the trigone of the left lateral ventricle and in the subcortical white matter of the cerebellum.There is a punctate focus at the trigone of the right lateral ventricle which is hyperintense on diffusion-weighted imaging but does not display any diffusion restriction on the ADC maps and appears represent T2 shine through.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 some mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI 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 disc desiccation present. Examination is somewhat degraded by patient motion.At C2-3 there is no significant compromise to the spinal canal. There is moderate left-sided facet hypertrophy present at this level. There is mild encroachment of the left-sided exiting nerve roots at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is marked left-sided facet hypertrophy present at this level. There is encroachment of left-sided exiting nerve roots at this levelAt C4-5 there is no significant compromise to the spinal canal. There is a moderate left-sided facet hypertrophy present at this level and mild right-sided facet hypertrophy. There is a small central disc protrusion present at this level. There is some encroachment of the left-sided exiting nerve roots within the left neural foramen at this level.At C5-6 there are endplate and uncovertebral osteophytes present associated with the effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the right-sided exiting nerve roots within the neural foramina. Overall there is a moderate degree of spinal stenosis at this level.At C6-7 there are endplate and uncovertebral osteophytes present associated with the effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the exiting nerve roots within the neural foramina. Overall there is a moderate degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction. Please note that the exam is somewhat degraded by patient motion which may obscure more subtle abnormalities.3.Some enlarged perivascular spaces in the basal ganglia and left thalamus may be a result of prior ischemic events.4.There are multilevel degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is a moderate degree of spinal stenosis present. There is additional multilevel encroachment of exiting nerve roots within the neural foramina as detailed above. Please note however that the cervical spine exam is degraded by motion artifact which may obscure more subtle abnormalities.5.Multiple microhemorrhages present in the subcortical white matter. Etiology is nonspecific. One possibility is amyloid angiopathy.