 ORBITS: The right optic nerve is slightly smaller in caliber than the left optic nerve. The optic nerves are otherwise normal in signal intensity. Failure of fat saturation on the coronal post-gadolinium images slightly limits evaluation, but no intraorbital mass or abnormal enhancement is convincingly identified. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is a subcentimeter focus of increased signal on DWI images in the right frontal periventricular white matter which does not have corresponding low signal on ADC images and demonstrates low T1 hypointensity; finding likely represents a subacute to chronic infarct. There is a lobulated, extra-axial collection along the bilateral superior frontal lobes measuring up to 9 mm in maximum thickness. The collection demonstrates heterogenous increased T1 signal, intermediate to low T2 signal, and low signal on susceptibility weighted images and is favored to represent a subacute to chronic subdural hematoma. The collection causes minimal local mass effect. Nonspecific scattered punctate foci of increased T2/FLAIR signal are present within the subcortical and periventricular white matter. There is nonspecific increased T2/FLAIR signal within the bilateral globus pallidi. There is no abnormal intracranial enhancement. Prominence of the cortical sulci and ventricles is compatible with moderate global cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is trace mucosal thickening within the paranasal sinuses. The midline structures and craniocervical junction are within normal limits.
1.Multifocal small extra-axial collections along the bifrontal convexities likely represent subacute to chronic subdural hematomas with minimal local mass effect. Follow-up noncontrasted CT may be obtained as clinically warranted.2.Subcentimeter focus of DWI signal hyperintensity in the right periventricular white matter without low signal on ADC which is favored to represent a subacute to chronic infarct.3.Additional scattered foci of white matter signal abnormality in the periventricular and subcortical white matter are nonspecific but favor chronic small vessel ischemic changes. Demyelinating disease considered less likely.4.T2 hyperintensity involving the globus pallidus bilaterally which is nonspecific but may be related to prior toxic-metabolic event.5.Moderate global cerebral volume loss.6.Minimally asymmetrically decreased caliber of the right optic nerve without associated optic nerve signal abnormality or abnormal enhancement.Notified Dr. Nichols's answering service of unexpected finding at 5:15 PM on 9/3/2015.