 There is an approximately 1.5 cm area of abnormal signal within the left precentral gyrus which exhibits increased signal on DWI images, isointense signal on ADC images, and increased signal on T2 images in pattern consistent with subacute infarction. There are additional punctate foci of increased DWI signal and decreased ADC signal compatible with acute microinfarctions within the superior paramedian pons, left middle cerebellar peduncle, left cerebellar hemisphere, and right ventral medulla. There is a small focus of chronic infarction within the right head of the caudate and anterior limb of the internal capsule with associated susceptibility artifact likely reflecting a small amount of mineralization and/or chronic blood products. There is additional confluent increased T2 signal within the bilateral periventricular and subcortical white matter compatible with moderate chronic small vessel ischemic changes. There is mild prominence of the ventricles including mild ex vacuo dilatation of the right lateral ventricle as well as prominence of the cortical sulci compatible with mild cerebral volume loss. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The vertebral artery flow voids appears slightly diminutive which may reflect atherosclerotic disease. Incidental note is made of a partially empty sella. Incidental note is made of hyperostosis frontalis interna. There is an approximately 1.6 x 1.0 cm lesion within the left frontal skull which displays decreased T1 signal, decreased T2 signal, and enhancement. There is a subcentimeter round lesion along the right anterior aspect of the falx without associated significant mass effect which demonstrates intrinsic T1 hyperintensity, possible mild enhancement, and susceptibility artifact which may be related to dural calcification or tiny meningioma.There is abnormally increased T2/FLAIR signal within the left globe, a fluid level within the posterior aspect of the left globe indicative of an effusion, and susceptibility artifact within the left globe reflecting mineralization or prior blood products. These findings may all be related to chronic retinal detachment.
1.Multifocal infarcts of different ages including acute, subacute, and chronic, as described above, including subacute infarct involving the left precentral gyrus and more acute microinfarcts within the superior paramedian pons, left middle cerebellar peduncle, left cerebellar hemisphere, and right ventral medulla. 2.Slightly diminutive flow voids within the intracranial vertebral arteries which may be related to atherosclerotic disease and could be further assessed with MRA or CTA if clinically indicated.3.Nonspecific 1.6 x 1.0 cm enhancing left frontal skull lesion. Comparison with prior outside examinations may be helpful.4.Incidental note of subcentimeter nodule in right parafalcine region which lacks mass effect and which may represent dural calcification or a tiny meningioma.Discussed with BURNS, MATTHEW at 11:50 a.m. on 9/11/2015. 