1. Mild to moderate scattered supratentorial white matter changes. In this age group, although findings are nonspecific, they most likely represent mild chronic small vessel ischemic/gliotic changes, not unusual for age.
2. Multiple small lacunes in the bilateral thalami and putamen, chronic in nature, related to prior small vessel occlusions.
3. Partially empty sella, sometimes incidental, sometimes indicative of increased intracranial pressure.
4. Involutional changes, not remarkable for age. Although there are no asymmetry components (ventricles > subarachnoid spaces) on cross-sectional standpoint to support Normal Pressure Hydrocephalus, today’s CSF flow study demonstrates increased velocities through the cerebral aqueduct, and I would not exclude this possibility. Strictly from an imaging standpoint, the more compelling findings when reviewing the CT IAC, MRI Brain, and CSF flow studies, are the CSF velocities and empty sella supporting a component of NPH. While the CT IAC suggests dehiscence on the left side, history states that clinical findings are in the right ear. The only caveat to this is a possible small right-sided channel dehiscence.
5. Small, sessile-appearing anterior communicating artery aneurysm (2 mm x 3 mm). This is a low-risk aneurysm at this point in time and I do not believe it merits treatment. I would, however, reevaluate it in 2 years to show stability with noncontrast MRA. I don’t think it is necessary at this time, but I would be happy to see this patient to review aneurysm findings and reassure the patient about following it.