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The lateral ventricles are dilated with extensive periventricular white matter T2 hyperintensity that is marked for age with associated diffuse white matter volume loss particularly in the frontal lobes. However there is relative crowding of the sulci at the vertex. Minimal upward bowing of the thinned corpus callosum. Although the walls of the 3rd ventricle are laterally bowed, the floor is not particularly depressed. The cerebral aqueduct is widely patent. Prominant aqueductal flow. Aqueductal stroke volume (noise corrected) is 107 microlitres, elevated. Blooming artefact in the pons, basal ganglia and the left frontal lobe in keeping with foci of previous microhaemorrhage with a distribution most in keeping with hypertensive bleeds.
Conclusion: Diffuse cerebral atrophy with a frontal predominance with evidence of chronic small vessel ischaemic change. However, there are also findings suspicious for concomitant chronic communicating hydrocephalus/NPH, particularly when in the appropriate clinical context.