Clinical question: Evaluate for intracranial abnormality. Signs and symptoms: Gait disturbance, tremor in LE. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates numerous periventricular foci of hyperintensity in bilateral cerebral hemispheres, minimal similar signal changes in the subcortical white matter of the hemispheres are also present. Tiny foci of flair hyperintensity in bilateral external capsules and pons are also identified. Findings are nonspecific however considering patient's stated age of 72 the likely represent chronic microvascular ischemic changes. These findings demonstrate no susceptibility signal changes. No detectable signal abnormality of cerebral cortex, cerebellum or vermis detected.Slight generalized prominence of hemispheric cortical sulci are noted. Correlate with history and neurological evaluation. Ventricular system remains within normal and with maintained midline. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Post enhanced images are negative for any abnormal enhancement of brain parenchyma, leptomeninges, calvarium, soft tissues of the scalp or the orbits.Unremarkable signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.
1.No acute intracranial process.2.Findings of mild chronic nonhemorrhagic small vessel ischemic strokes more prominent in the periventricular white matter and minimally in the subcortical, bilateral external capsules and pons.3.Mild generalized prominence of cortical sulci without signal abnormality and unremarkable pre-and post enhanced brain MRI otherwise.