77 years, Male, parkinsonism, dementia.. Left-sided spasticity. Brain: There is severe volume loss involving the bilateral anterior and medial temporal lobes including the bilateral hippocampi with pronounced ex vacuo dilatation of the bilateral temporal horns. There is associated FLAIR hyperintensity compatible with nonspecific gliosis. There is also more generalized global parenchymal volume loss. No findings to suggest hydrocephalus. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Multiple patchy areas areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic changes. Major flow-voids are preserved.There is evidence of bilateral intraocular lens replacement. There appears to be a small circumferential effusion within the right globe suggestive of prior ocular detachment. Ovoid densities are noted in the inferior aspect of the bilateral globes. Suggest correlation of these findings with prior surgical history examination.Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are grossly within normal limits. Cervical spine: Examination is mildly motion degraded. Vertebral body heights in the cervical spine are normal. There is partial ankylosis involving the C2 and C3 vertebrae. There is mild retrolisthesis of C3 on C4 and C5 on C6. Bone marrow signal is benign. No suspicious osseous lesions are demonstrated. No cord signal abnormality.Multilevel degenerative changes, individual described below:C2-3: Partial osseous fusion. No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is disc osteophyte complex with uncovertebral hypertrophy resulting in moderate left-sided neural foraminal stenosis. No significant right neural foraminal narrowing.C4-5: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to facet arthropathy.C5-6: Mild spinal canal narrowing related to disc osteophyte complex and ligamentum flavum thickening. There is also minimal right neural foraminal narrowing. Left neural foramen is patent. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. No evidence of acute infarct, hemorrhage, or intracranial mass. 2. Mild to moderate chronic small vessel ischemic disease.3. Pronounced volume loss involving the bilateral anterior and medial temporal lobes. There is associated T2/FLAIR hyperintensity compatible with nonspecific gliosis. Findings may be related to neurodegenerative disorder such as Alzheimer's, although sequela of prior encephalitis or other injury are possibilities.4. Multilevel degenerative changes in the cervical spine without high-grade spinal canal stenosis or cord signal abnormality. Additional details as above.5. Bilateral ocular findings, as described above, which can be correlated with surgical history.