Female, 78 years old, with weakness. A focus of mildly restricted diffusion measuring up to 1 cm is seen in the left cerebellar hemisphere with mild associated FLAIR hyperintensity. No other definite areas of restricted diffusion are seen.Extensive scattered parenchymal encephalomalacia is noted, mostly affecting the right cerebral hemisphere with lesions in the frontal, parietal and temporal lobes. There is corresponding T2 hyperintensity compatible with gliosis, and volume loss in the form of ventricular ex vacuo dilatation and widening of the sulci. Several small foci of encephalomalacia are also noted in the bilateral cerebral hemispheres.No evidence of significant parenchymal edema or generalized mass effect is seen. No abnormal extra-axial fluid or intracranial hemorrhage is suspected. No pathologic parenchymal or extra-axial enhancement is seen.
1.Small focus of late acute or subacute ischemia in the left cerebral hemisphere.2.Extensive chronic territorial ischemic disease affecting predominantly the right cerebral hemisphere.3.No definite additional acute intracranial abnormalities.