Parkinson disease. Paralysis agitans. Presurgical planning for deep brain stimulator placement. The study is significantly limited by patient motion. There are scattered frontoparietal white matter T2 hyperintense foci that are noncontrast-enhancing and non diffusion-restricted. These are most compatible with chronic microvascular ischemia. Additionally within motion limitation, there is narrowing and blurring of the pars compacta of the substantia nigra which also loses its expected T2 hyperintensity. These findings are also associated with generalized enlargement of the sulci and other CSF-containing spaces reflecting volume loss. There is a 1 cm, left anterior frontal, contrast-enhancing dural-based mass that is isointense to gray-matter on both T1 and T2. This is associated with mild thickening of the adjacent dura as well as minimal skull inner table hyperostosis. This is most compatible with a meningioma. Otherwise, there is no mass effect or midline shift. There is no intracranial hemorrhage. Major intracranial vessels are patent.There is minimal mucosal thickening in the maxillary sinuses without fluid, which is likely of no significance.
1.Study limited by patient motion as described above.2.Substantia nigra changes along with generalized brain volume loss patible with known Parkinson's disease.3.Frontoparietal white matter changes are probably chronic microvascular ischemia.4.1 cm left frontal dural based mass consistent with incidental small convexity meningioma.Given the presence of significant patient motion degrading the study for preplanning purposes, and after discussion with the ordering physician, the study (Axial T1) will be repeated with sedation and a QSM (quantitative susceptibility mapping) sequence will be obtained as well.