60-year-old male with HIV, ESRD, and seizure disorder. Persistent somnolence and new hyperreflexia. Evaluate for intracranial masses. Brain: No intracranial mass or mass effect. No diffusion restriction to suggest acute ischemia. Moderate degree of T2/FLAIR hyperintensity in the periventricular white matter is unchanged. Susceptibility effect and volume loss involving the right anterior basal ganglia remains unchanged and compatible with hemorrhagic infarct. Small chronic lacunar infarct involving the upper aspect of the left thalamus also suspected. There is a peripheral punctate focus of microhemorrhage involving the right inferior parietal lobule. Few punctate additional foci of chronic microhemorrhage in the posterior fossa are also questioned but suboptimally evaluated due to motion degradation. No areas of edema or mass effect are seen. No acute intracranial hemorrhage or abnormal extra axial fluid collection is seen. The ventricles and sulci are prominent compatible with parenchymal volume loss. Major flow-voids are preserved. Mild opacification involving the paranasal sinuses. Calvarium and extracranial soft tissue structures are grossly unremarkable.Cervical Spine: Examination is motion degraded however demonstrates no evidence of high-grade stenosis in the cervical spine. There are multilevel degenerative changes with small disc osteophyte complexes, relatively worse at the C4-C5 level where central disc protrusion and ligamentum flavum thickening are associated with mild to moderate spinal canal stenosis. Mild spinal canal stenosis is also evident at C6-C7. Multilevel facet arthropathy. No cord signal abnormality is appreciated. Neural foraminal stenosis of mild to moderate degree is evident at the right C4-C5, C5-C6, and bilateral C6-C7 levels, but suboptimally evaluated due to motion degradation. Vertebral body heights and alignment are maintained.
1. No intracranial mass or mass effect. No evidence of acute ischemia.2. Evidence of moderate chronic small vessel ischemic disease as well as chronic hemorrhagic infarct in the right anterior basal ganglia is again seen. Global parenchymal volume loss which is slightly advanced for age also again noted.3. Cervical spine study is significantly motion degraded. There is up to mild-to-moderate spinal canal stenosis at the C4-C5 level related to degenerative changes. No evidence of higher grade spinal canal stenosis or appreciable cervical cord signal abnormality.