 There is a small focus of acute infarction in the left temporal lobe on series 501 image 208. There are additional punctate foci of acute infarction in the left occipital lobe on series 501 image 214. There are also small punctate foci of restricted diffusion in the central pons (series 501 image 206). There are other foci of increased DWI signal without definite corresponding decreased ADC signal or T2 hyperintensity in the left frontal and parietal lobes, which may represent less acute ischemia. There are foci of punctate susceptibility effect in the bilateral cerebellar hemispheres, vermis, pons, left thalamus, and left frontal lobe probably representing chronic microhemorrhages. There is diffuse confluent vasogenic pattern T2 signal abnormality in the subcortical and periventricular white matter in both supratentorial and infratentorial brain representing chronic hypertensive changes as they correspond to confluent hypodensity on prior remote CT as well. There is unchanged bifrontal encephalomalacia, left greater than right with expected ex vacuo dilatation of the frontal horns. There is a small left frontal bone defect with foci of susceptibility representing osseous fragments, unchanged from prior CT. The ventricles and sulci are unchanged.
1.Small to punctate foci of acute infarction in the left temporal lobe, left occipital lobe, and the central pons.2.Diffuse vasogenic pattern T2 confluent signal abnormality consistent with background chronic hypertensive encephalopathy as they were present on prior remote CT as well. Superimposed acute findings related to posterior reversible encephalopathy syndrome may be present in the cerebellar hemispheres bilaterally due to possible mild mass effect suspected in the cerebellar hemispheres, although it is difficult to distinguish the acute findings from the background of extensive chronic hypertensive findings.3.Bifrontal encephalomalacia, left greater than right, with small left frontal calvarial defect and tiny foci of bone within the left frontal region of encephalomalacia, unchanged.Findings were discussed with cardiology intern Dr. Zhang over the telephone at 5:10 p.m. today.