Parkinsonism. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mildly prominent susceptibility effect in the bilateral putamina, left greater than right. There may be slightly diminished susceptibility low signal in the substantia nigra. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is a 17 mm wide retrocerebellar arachnoid cyst. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.
Mildly prominent susceptibility effect in the bilateral putamina, left greater than right, may raise the possibility of MSA-P, although not conclusively so. Otherwise, no structural lesions are identified.