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There are are a few, less than 5, punctate flair hyperintensities in the cerebral white matter likely to reflect small vessel ischaemic changes. There is an old lacunar infarct in the left thalamus and a small old infarct in the superior aspect of the left cerebellar hemisphere. There is selective biparietal volume loss with the widening of the adjacent cortical sulci. There is associated decreased perfusion on ALS perfusion scan (not shown). There is preservation of the frontal and temporal parenchymal volume. There is normal calibre of the ventricles. There is also mild bilateral superior cerebellar hemispheric volume loss.
There is no diffusion restriction or pathological parenchymal susceptibility artefact. There is no intracranial mass lesion or collection. There is preservation of the major intracranial arterial flow voids.
There is selective biparietal parenchymal volume loss with associated decreased perfusion on ALS perfusion scan. The appearance is non-specific but has been described in Alzheimer's disease. There is also mild superior cerebellar hemispheric volume loss.