Nuchal rigidity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive areas of encephalomalacia in the bilateral basal ganglia and thalamic regions, with associated Wallerian degeneration. There are also small areas of encephalomalacia in the cerebellar hemispheres. There is diffuse cerebral volume loss with superimposed ex vacuo dilatation of the right lateral ventricle. There is mild nonspecific periventricular white matter T2 hyperintensity diffusely. There is no abnormal intracranial enhancement, although the assessment is limited by the weak contrast distribution. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right frontal sinus.
1. No evidence of intracranial abscess or abnormal meningeal enhancement, although the assessment is limited by the weak contrast distribution. 2. Multiple chronic lacunar infarcts in the bilateral basal ganglia and thalamic regions, as well as the cerebellar hemispheres, but no evidence of acute infarction.