Clinical question: Evaluate for structural lesions, previous ischemia, previous CEA. Signs and symptoms: Severe tremor. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is a small focus of encephalomalacia in the left occipital lobe consistent with a chronic ischemic stroke. Additionally there are multiple small foci of FLAIR/T2 hyperintensity involving the cortex and subcortical white matter as well as periventricular white matter of bilateral cerebral hemispheres suggestive of multiple prior chronic small vessel ischemic strokes and small cortical strokes. The appearance of the findings could suggest watershed some strokes.There is disproportionate prominence of cortical sulci and to a lesser degree cerebellar and vermin folia patient's stated age of 64. Ventricular system are slightly prominent and with maintained midline.The signal void of major intracranial branches are identified.Unremarkable calvarium and soft tissues of the scalp. Unremarkable images through the orbits.Prostate air cells demonstrate diffuse bilateral patchy nonspecific opacification.Paranasal sinuses demonstrate frontal, sphenoid left greater than right anterior ethmoid sinus disease.
1.No acute intracranial process and negative diffusion weighted series.2.Multiple small cortical, subcortical and periventricular white matter chronic ischemic strokes of bilateral cerebral hemispheres as detailed above.3.Generalized prominence of cortical sulci, mild prominence of the supratentorial ventricular system and cerebellar- vermian folia for the patient's stated age.4.Chronic sinusitis as detailed.