65-year-old female patient with history of thalamic hemorrhage and microvascular disease presents with head fullness. There is mild continued evolution of chronic blood products related to left thalamic hemorrhage with residual susceptibility artifact. Again seen is susceptibility artifact compatible with hemosiderin scar in the right external capsule, appearing similar compared to prior exam. Bilateral punctate foci of susceptibility artifact in the bilateral frontal and occipital lobes as well as the basal ganglia appear similar compared to prior examination and are consistent with prior microhemorrhages. There is extensive pons and periventricular and subcortical white matter T2/FLAIR increased signal intensity without associated restricted diffusion that is not significantly changed compared to prior exam and consistent with moderate chronic small vessel ischemic disease. There is no abnormal enhancement on postcontrast images.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The paranasal sinuses, mastoid air cells and orbits are unremarkable. The skull and extracranial soft tissues are unremarkable.
1.No acute infarct, hemorrhage, mass or mass effect.2.Mild continued evolution of chronic left thalamic hemorrhage. Stable hemosiderin scar within the right external capsule from remote hemorrhage. No significant change in multiple additional parenchymal microhemorrhages on background of advanced chronic small vessel ischemic disease. These findings are suggestive of chronic hypertensive encephalopathy and/or amyloid angiopathy.