 There is no evidence of intracranial hemorrhage, mass, or mass-effect. There are no acute diffusion abnormalities. There are scattered foci of T2 hyperintensity throughout the periventricular and subcortical white matter which may be related to chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size and enhances normally. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. There is no abnormal enhancement within the brain. There is slight widening of the atlantondental interval measuring up to 4 mm. There are multiple areas of punctate T2 hyperintensity diffusely throughout the parotid glands bilaterally. The right ostiomeatal unit is opacified.
1. Scattered foci of T2 hyperintensity within the periventricular and subcortical white matter likely represent chronic small vessel ischemic disease. No evidence of acute infarct.2. There is slight widening of the atlantodental interval, which is never completely imaged on prior exams. In the absence of trauma this could relate to inflammatory arthritic changes. Correlation with history and physical exam is recommended, and dedicated follow-up imaging could be considered.3. Punctate T2 hyperintensity diffusely throughout the parotid glands bilaterally is nonspecific although may be related to Sjogren's, sarcoid, or other inflammatory etiology.