 There multiple patchy foci of decreased diffusion throughout the right frontal, parietal, and occipital lobes predominantly in a watershed distribution. This minimal susceptibility effect associated with more confluent regions in the right precentral gyrus with adjacent prominence of the sulcal vessels throughout the right frontal lobe. There is also mild leptomeningeal enhancement with apparent nodularity at the right central sulcus (or tortuous dilated vessels). In addition, there multiple punctate foci of T2 hyperintensity within the left sided supratentorial white matter. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses and scalp soft tissues are unremarkable. The skull is mildly thickened.
1.Numerous foci of restricted diffusion throughout the right cerebral hemisphere are most compatible with acute/subacute infarcts. These appear predominantly in the watershed distribution. Small foci of susceptibility are also seen indicative of petechial hemorrhages. There is prominence of the pial collaterals with mild leptomeningeal enhancement and apparent nodular enhancement at the right central sulcus. This nodularity may be related to tortuous dilated collateral vessels; however, if there is possibility of underlying infection and infectious vasculopathy, suggest lumbar puncture and vascular imaging for further evaluation. 2.Additional nonspecific punctate foci of T2 hyperintensity throughout the left cerebral hemisphere.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.