 Several sequences are limited by patient motion. There is redemonstration of asymmetric severe right and moderate left cerebellar atrophy associated extensive susceptibility along the residual right cerebellar parenchyma extending into the right pons and medulla which also demonstrate asymmetric volume loss. There is no significant associated FLAIR abnormality. Minimal areas of linear and somewhat ill-defined enhancement along the right cerebellar tissue without a masslike configuration. There is ex vacuo dilatation of the fourth ventricle, more prominent on the right side. There is no significant FLAIR abnormality. A focus of susceptibility is identified in the right lateral thalamus, corresponding to previously noted CT. Other punctate foci of calcifications seen along the right deep gray nuclei are not well appreciated on this MRI.The lateral and third ventricles are within normal limits. The cerebral sulci are mildly prominent, suggestive of mild global volume loss slightly greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There are few scattered punctate foci of T2/FLAIR hyperintensity in subcortical white matter within the frontal lobes which are nonspecific. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The structures and craniocervical junction are within normal limits. There is mild mucosal thickening in all the paranasal sinuses bilaterally. Aerated secretions are seen in the right sphenoid sinus.
1.Redemonstration of severe right and moderate left cerebellar atrophy with associated right pontine and medullary atrophy. Corresponding coarse calcifications on the right in the posterior fossa and along the brainstem, with minimal scant enhancement felt to relate to areas of scarring. Findings are suggestive of a chronic process with dystrophic calcifications, perhaps relating to sequela of previous infectious/inflammatory process such as cerebellitis or previous vascular insult. Neurodegenerative disorder remains within the differential and can be associated with autoimmune, para neoplastic, and toxic/metabolic abnormalities.2.No significant supratentorial abnormality aside from mild global volume loss, with a few scattered nonspecific punctate foci of T2/FLAIR hyperintensity no MR evidence of demyelinating disease as clinically questioned.3.Aerated secretions in the right sphenoid sinus. Please correlate clinically for acute sinusitis.