 MRI BRAIN:The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is minimal scattered periventricular and subcortical T2 hyperintensities which are nonspecific but likely related to chronic small vessel ischemic disease. There is also extensive confluent increased T2 signal in the pons with peripheral sparing and no associated diffusion restriction. There is overall no diffusion abnormality.No extra-axial fluid collection is identified. Rightward deviation of the nasal septum is unchanged. Right maxillary mucus retention cyst/polyp. Mild mucosal thickening of the right sinuses. Pituitary is prominent but measures within normal limits, likely accentuated by a relatively small suprasellar cistern. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA brain:The internal carotid arteries are patent without evidence of stenosis or aneurysm. No significant stenosis or aneurysm is identified within the MCAs. The right A1 is hypoplastic. PCOM arteries identified bilaterally. The posterior circulation is patent without significant stenosis or aneurysm. There is a dominant left vertebral artery.
1.Increased T2 signal within the pons without diffusion restriction. Differential includes metabolic etiologies, demyelinating processes including central pontine myelinolysis, and chronic small vessel ischemic changes although somewhat atypical given relative lack of supratentorial abnormality. Neoplasm felt to be unlikely. Please correlate clinically. No evidence of acute infarct.2.Minimal periventricular and subcortical T2 hyperintensities are nonspecific but likely related to chronic small vessel ischemic disease.3.No evidence of aneurysm or significant stenosis.