86 years, Male, altered mental status, assess flow through the third ventriculostomy. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is no significant change in size of the ventricular system compared to MRI dated 4/29/2016. Global parenchymal volume loss is again evident. Prominence of the extra-axial spaces again seen with decrease in a small amount of blood products associated with the subdural effusion seen previously. Unchanged focus of pineal region calcification which narrows the cerebral aqueduct and mildly deforms the tectal plate. There is a prior right transfrontal ventriculostomy tract which is again seen. The third ventriculostomy is favored to be patent as evidenced with preservation of flow void at this level. The gated CSF flow sequence is however nondiagnostic despite multiple attempts related to patient's atrial fibrillation.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Small chronic cortical infarcts such as the left middle frontal gyrus and right peri-Rolandic region again seen. Scattered foci of susceptibility compatible with chronic microhemorrhages are again seen.
1. No evidence of acute infarct.2. No significant change in size of the ventricular system which remains prominent compared to MRI dated 4/29/2016. Parenchymal volume loss as well as calcification in the pineal region narrowing the cerebral aqueduct are again seen. 3. CSF flow sequence is nondiagnostic as described above limiting assessment for third ventriculostomy patency but is likely patent as evidenced by flow-void on the sagittal T1 sequence across the floor of the third ventricle. 3-D T2 sequence may also be helpful for further visualization.