Gait instability, enlarged ventricles, concern for NPH. There is prominence of the lateral and third ventricles, perhaps slightly out of proportion to some of the sulci. In fact, bilateral parietal lobe sulci are prominent. There is moderate cerebral white matter T2 hyperintensity, mainly in a periventricular distribution. There are also punctate foci of T2 hyperintensity in the bilateral thalami. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Prominence of the lateral and third ventricles, perhaps slightly out of proportion to some of the sulci may represent normal pressure hydrocephalus superimposed on cerebral volume loss. 2. Cerebral white matter T2 hyperintensity, mainly in a periventricular distribution, is nonspecific, but may represent chronic small vessel ischemic disease, and lesions in the bilateral thalami may represent chronic infarcts. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.