Subtle parkinsonism and difficulty swallowing with positive OPM, vertical eye movements also impaired History: see above. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is blurring of the bilateral substantia nigrosome susceptibility. There is mild scattered cerebral white matter T2 hyperintensity bilaterally. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implantsNeck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The upper aerodigestive tract appears to be intact. The osseous structures are unremarkable, aside from small anterior and posterior disc-osteophyte complexes at C6-7 and C7-T1.
1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Blurring of the bilateral substantia nigrosome susceptibility is suggestive of Parkins disease. 3. Mild scattered cerebral white matter T2 hyperintensity bilaterally is nonspecific, but may represent chronic small vessel ischemia. 4. No evidence of tumors in the neck.