Neurodegenerative disease, altered mental status, and rigidity. There is marked atrophy of the bilateral caudate nuclei. There is a background of moderate diffuse cerebral volume loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral and pontine white matter T2 hyperintensity. There are defects in the right centrum semioval and bilateral thalami and corona radiata and with degeneration in the left midbrain. There is encephalomalacia in the left inferior cerebellar hemisphere. There is no abnormal intracranial enhancement. 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 scattered paranasal sinus mucosal thickening and secretions. There is a probable Thornwaldt cyst that measures up to 14 mm.
1. Disproportionate volume loss of the bilateral caudate nuclei is suggestive of Huntington disease.2. Chronic small vessel ischemic disease and lacunar infarcts in the left cerebellum and bilateral thalami and corona radiata with left-sided Wallerian degeneration, but no evidence of acute intracranial hemorrhage, mass, or acute infarction.