Diagnosis: Dementia, unspecified, without behavioral disturbance Memory lossClinical question: eval for structural lesionsSigns and Symptoms: dementia, incontinence The lateral ventricles the third ventricle and to a lesser fourth ventricle are fairly large relative to the sulci.There are T2 and FLAIR signal hyperintense periventricular and subcortical white matter lesions of a moderate to marked degree within the periventricular and subcortical white matter. They have a rather confluent pattern. Additionally there is a marked degree of a signal hyperintense foci scattered throughout the thalami. To a lesser degree there is a mild to moderate moderate degree of FLAIR and T2 signal hyperintense lesions in the midbrain and pons as well as the basal ganglia.No significant degree of lesions with susceptibility effect are appreciated intracranially.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.Periventricular and subcortical white matter signal changes of a marked degree are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 2.There are additional lesions scattered throughout the thalami and to a lesser degree pons, basal ganglia and midbrain which could also be related to a neurodegenerative process or vascular related. There are nonspecific as well.3.The ventricles are large. The possibility of normal pressure hydrocephalus cannot be excluded.