Chronic hypertensive encephalopathy
Short stride length and some parkinsonian features. Cognitive decline.
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Susceptibility weighted imaging demonstrates numerous microhemorrhages mostly scattered throughout the basal ganglia, thalami, pons and cerebellar hemispheres. Hemorrhagic lacunae are seen in the left striatum and right corona radiata. Extensive chronic small vessel ischemic change. There is generalized volume loss without a particular lobar pattern associated with ex vacuo dilatation of the ventricles. The midbrain is normal in size. Hippocampi are commensurate to the remainder of the brain.
This patient had a known and well documented long history of poorly controlled hypertension. The imaging features are typical of chronic hypertensive encephalopathy and prominent chronic small vessel ischemic change.