68 years, Female, metastatic leiomyosarcoma. Evaluate for metastasis. No intracranial mass or abnormal enhancement to suggest metastatic disease. Patchy foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. There is mild parenchymal volume loss and possible mild disproportional enlargement of the ventricular system for the degree of volume loss which along with focal expansion of the CSF spaces, particularly in the parieto-occipital region, raises possibility of communicating hydrocephalus in the appropriate clinical setting. Mega cisterna magna incidentally noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Major flow-voids are preserved. There is osseous protuberance involving the left temporal inner table which represent osteoma. Rightward nasal septal deviation. Calvarium and extracranial soft tissues are otherwise grossly unremarkable.
1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic changes.3. Suspected mild disproportionate enlargement of the ventricular system for the degree of volume loss, which raises possibility of communicating hydrocephalus/NPH in the appropriate clinical setting.