Lack of coordinationClinical question: evaluate for CVASigns and Symptoms: evaluate for CVA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of high signal on T2 and FLAIR are present basal ganglia, brainstem and thalami .There is a hypointense focus on susceptibility imaging is present in the pons. There are additional punctate foci of low signal on susceptibility imaging in the periventricular white matter. Incidental noted is made of partial empty sella.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.There is anterior subluxation of C1 on C2 associated with narrowing of the spinal canal.
1.There is subluxation of C1 on C2 associated with what appears to be spinal stenosis. Please correlate with clinical findings. Additional imaging may be of further benefit.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. Additional lesions in the basal ganglia, brainstem and thalami are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction.4.A microhemorrhage is present within the pons. This is likely from an old hemorrhage.5.At the time of the dictation a page with callback # was sent to the hospitalist - Bryan Campbell - to report the above findings.