 There is a punctate focus of contrast enhancement with associated susceptibility hypointensity within the superior right cerebellum (series 1201 image 66, series 701 image 75). There are no definite other foci of enhancement. T2 hyperintense foci are present within the white matter without associated restricted diffusion, enhancement, or susceptibility abnormality. There is diffuse volume loss with a superimposed somewhat predominant right parietal lobe atrophy pattern. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered foci of sporadic mucosal thickening can be found and the paranasal sinuses. Fluid is noted in the dependent right mastoid air cells. The left mastoid air cells are clear. There is no abnormal enhancement within the brain.
1.There is a punctate focus of contrast enhancement with associated susceptibility hypointensity within the superior right cerebellum (series 1201 image 66, series 701 image 75) suspicious for a tiny hemorrhagic metastasis.2.Chronic small vessel ischemic disease.3.There is diffuse volume loss with a superimposed somewhat predominant right parietal lobe atrophy pattern.