Intermittent twitching, gait instability, and lightheadedness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive diffuse patchy and scattered cerebral white matter T2 hyperintensity without corresponding restricted diffusion. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a defect in the left lamina papyracea, which may represent a chronic blow-out fracture. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is fluid signal within the right mastoid air cells.MRA: There is no evidence of significant steno-occlusive lesions. There is a prominent right superior hypophyseal artery infundibulum, but no evidence of aneurysm.
1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Extensive cerebral white matter T2 hyperintensity likely represents chronic small vessel ischemic disease. 3. Right mastoid fluid may represent mastoiditis.4. No evidence of significant steno-occlusive lesions. 