Findings:
Marked volume loss is seen involving the mesiotemporal structures on both sides (MTA 4), with relative sparing of the rest of the temporal lobe. Moderate volume loss is also noted in the parietal lobes bilaterally (Koedam 2).
No intra or extra-axial blood or fluid collection is present. There is no mass or shift of midline.
Confluent zones of decreased attenuation involving the subcortical and periventricular cerebral white matter are noted, in keeping with advanced small vessel ischemic disease (Fazekas 3).
No loss of the grey-white matter junction is seen.
A well-defined mass is seen in the quadrigeminal plate cistern with fat attenuation, unchanged to the previous study, compatible with quadrigeminal cistern lipoma.
Partially empty sella is noted.
Moderate atherosclerotic changes are noted involving the intracranial ICA bilaterally.
No calvarial fracture or suspicious bony abnormality seen. Hyperostosis frontalis interna is seen.
Bilateral IOL-implants are seen. The imaged paranasal sinuses and the mastoid air cells are clear.
Impression:
No acute intracranial process.
Marked bilateral mesiotemporal atrophy, in keeping with Alzheimer disease. Also, advanced small vessel ischemic disease (Fazekas 3).
Incidental finding of a quadrigeminal cistern lipoma.