50 years, Male, gait disturbance and hyperreflexic. Evaluate for brain lesion. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage, intracranial mass or mass-effect. There is sulcal and ventricular prominence, compatible with moderate generalized parenchymal volume loss, greater than expected for age. There is no hydrocephalus.Several foci of T2 hyperintensity are seen in the bilateral subcortical and periventricular white matter. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement is identified. Normal flow-voids are present within the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
1.Several foci of T2 hyperintensity within the bilateral subcortical and periventricular white matter are nonspecific, and statistically most likely represent chronic small vessel disease. However, other differential considerations include migraine sequela, infectious/inflammatory etiology, trauma or demyelinating disease.2.Moderate generalized parenchymal volume loss, greater than expected for age.