84 years Male (DOB:3/12/1931)Reason: r/o progression of leptomeningeal pathology (unclear origin, progressive word finding difficulties and cerebellar findings on exam) History: progressive word finding difficulties and cerebellar findings on examPROVIDER/ATTENDING NAME: TANGUY Y LIM-SEIWERT TANGUY Y LIM-SEIWERT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of some leptomeningeal signal hyperintensity along the right central sulcus this has not resolved since the prior exam it is not associated with susceptibility effect.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate foci of T2 and FLAIR signal hyperintensity in the brainstem and left thalamus as well as the basal ganglia.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is some leptomeningeal disease present along the right central sulcus. The underlying cause cannot be established on this exam. Please correlate with clinical symptoms. Perhaps a contrast-enhanced exam would be helpful if that would be clinically possible.2.Punctate lesions in the brainstem, left thalamus and basal ganglia most likely represent prior ischemic insults.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 