Ataxia and nausea. Lesion in the left middle cerebellar peduncle on outside MRI. BRAIN: There is interval evolution of the left middle cerebellar hemisphere lesion, with what now appears to be encephalomalacia. There are also small foci encephalomalacia involving the periphery of the bilateral cerebellar hemispheres, left larger than right, which have appear to be new. In addition, there is also mild cerebellar volume, mainly involving the vermis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The cerebral parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is a minimal C5-C6 disc-osteophyte complex. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is no abnormal contrast enhancement.
1.Several small foci of encephalomalacia in the cerebellum likely represent chronic infarcts superimposed upon mild vermian atrophy, which may be related to alcohol use. MRA of the head and neck may be useful for further evaluation.2.The cervical spinal cord is unremarkable.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.