Wk 4, Case 4 - Review

Patient History
69-year-old female with left eye pain and numbness in the left upper and lower extremity.

Findings
MRI BRAIN:

There is no abnormal restricted diffusion to suggest acute or subacute infarct. No abnormal extra-axial fluid collection. No mass or mass effect. No abnormal enhancement. There is mild age-related parenchymal volume loss with proportional enlargement of the ventricles and sulci. Old lacunar infarct is noted in the right thalamus. Tiny hypodensity along the right ventral medulla, best seen on series 9 image 10 is likely artifactual given its is not reproducible on other sequences. Scattered foci of T2/FLAIR hyperintensity are noted in the supratentorial subcortical, deep and periventricular white matters, nonspecific but could be due to chronic microvascular ischemic changes. The larger intracranial vascular flow voids are maintained. There is mildmucosal thickening in the paranasal sinuses. Mastoid air cells are grossly well aerated. Intraorbital contents are within normal limits.


The susceptibility weighted scans show diffuse hemosiderosis affecting the structures of the posterior fossa as well as the sylvian fissures and paramedian parafalcine leptomeninges. Chronic blood products are also seen in the ependyma of the ventricles. The surface of the brainstem is coated with hemosiderosis.

MRA HEAD:

No large branch arterial occlusion, significant arterial stenosis or saccular aneurysm is demonstrated. Distal internal carotid arteries are unremarkable. Anterior cerebral arteries are symmetric and patent. Both middle cerebral arteries are patent. Vertebrobasilar system and is major branches are normal in contour and caliber bilaterally.

MRA NECK:

The imaged aortic arch is normal. The origins of the innominate, bilateral common carotid, bilateral subclavian and bilateral vertebral arteries demonstrate no significant stenosis. Left vertebral artery is slightly more dominant. No significant ICA stenosis is noted involving the bilateral internal and external carotid arteries.

Impressions
1. Hemosiderosis. The remote spinal surgery could be the etiology for the source of the hemosiderin.
2. Old lacunar infarct in the right thalamus.
3. Patent vasculature of the head and neck.