Parkinsonism disease (MR).

PROTOCOL:

T1W – Sagittal & axial scans
T2W – Axial & coronal scans
FLAIR – Axial scans

FINDINGS:

Revealed:

-Peri ventricular diffuse hyper intensity with multiple, variable sized foci of altered MR signal in deep and superficial white matter surrounding ventricles and in both centrum semi ovale areas. These foci show hypo intense signal on T1 and hyper intense signal on T2 and Flair images with restricted diffusion.
-At least two foci of altered signal are also noted in the left side of the mid pons with the same MR specification of the above mentioned lesions.
-The right substantia nigra shows reduction in its normal hypo intensity suggesting atrophy.
-No focal mass lesion is seen.
-Lateral and third ventricles are prominent in size and position. Septum is in midline.  There is no midline shift.
-Basal cisterns, cortical sulci and gyri are prominent in appearance.
-Normal morphology of cerebellum.
-Corpus callosum shows normal MR morphology.
Fourth ventricle is normal in size and is midline in position.


OPINION:

-Atrophy of the right substantia nigra; suggestive of Parkinsonism disease for clinical correlation.
-Diffuse small vessel disease of the brain.
-Two recent lacunar infarcts affecting pons.
-Brain atrophy.


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Swallow tail sign