Right sided weakness and sensory change. There are punctate foci of restricted diffusion and high T2 signal in the upper left precentral gyrus and paracentral lobule. There is a background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the bilateral basal ganglia and corona radiata. There is also encephalomalacia and susceptibility effect in the right posterosuperior temporal lobe and inferior parietal lobule. There is a pineal cyst that measures 9 mm in diameter. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. There is a 9 mm diameter basilar tip aneurysm. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Punctate recent infarcts in the left upper left precentral gyrus and paracentral lobule.2. Chronic lacunar infarcts in the bilateral basal ganglia and corona radiata. 3. Area of chronic hemorrhagic infarction in the right posterosuperior temporal lobe and inferior parietal lobule. 4. A background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity may represent chronic small vessel disease. 5. A 9 mm diameter basilar tip aneurysm appears to have gradually increased in size. 