Clinical question: 66 year old male with history of orthostatic hypotension, gait disorder, parkinsonism, suggestive of Multisystem Atrophy. Signs and symptoms: Status ataxia, orthostasis. Pre and post enhanced brain MRI:Unremarkable diffusion-weighted images. Examination demonstrates symmetrical bilateral mild prominence of cortical sulci slightly more pronounced in the parietal region for patient's stated age.Few punctate foci of FLAIR hyperintensity in the subcortical and periventricular white matter is a nonspecific finding however in proper clinical setting could represent minute chronic small vessel ischemic disease. There is no detectable signal abnormality of brain parenchyma otherwise on any of the MRI sequences and there is no detectable abnormal enhancement of brain parenchyma or the meninges.Calvarium and images through the orbits are unremarkable and without abnormal enhancement.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.No acute intracranial process.2.Mild prominence of cerebral cortical sulci slightly more conspicuous in parietal lobes for age.3.Few punctate nonspecific FLAIR hyperintensity only in the periventricular and subcortical white matter.4.Unremarkable pre and post enhanced brain MRI otherwise.