60-year-old male with acute neurologic change, anisocoria, facial twitching. Brain MRI:There is no acute infarct or intracranial hemorrhage. There is mild-to-moderate involvement of the frontoparietal white-matter by patchy T2 hyperintense lesions, which is nonspecific though likely represent chronic microvascular ischemia. There is mild-to-moderate brain volume loss. There is diffuse ventricular enlargement which is slightly more pronounced than the enlargement of the sulci and basal cisterns. There is also an empty sella, which is likely an incidental finding at this age. There is fluid signal in the mastoid air cells, bilaterally, which might be congestive in nature. There is minimal dependent fluid in the sphenoid and posterior ethmoid sinuses. The skull is mildly diffusely thickened, which is nonspecific.Cranial MRA:The left internal carotid artery is slightly smaller than the right along with a hypoplastic left A1 segment. There is preserved flow in the left A2 segment through an enlarged anterior communicating artery. Otherwise, there is no flow limiting intracranial arterial stenosis or aneurysm.Neck MRA:This is a noncontrast-enhanced examination, which is limited, especially for the assessment of the origins of the neck vessels.The left cervical carotid arteries are slightly smaller than the right which is probably congenital. Otherwise, there is no high-grade focal stenosis of the cervical carotid or vertebral arteries.
1.No evidence of acute infarct, hemorrhage, or intracranial mass effect.2.Moderate cerebral changes of chronic microvascular ischemia and mild brain volume loss. Ventricular dilatation appears slightly out of proportion to the degree of volume loss raising a possibility of normal pressure hydrocephalus/communicating hydrocephalus in the appropriate clinical setting.3.No significant cranial or cervical stenoocclusive disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.