History of right-sided gaze deviation of unresponsiveness following right hemicolectomy. Previous lacunar strokes with left-sided weakness. There is extensive patchy and confluent high T2 signal in the periventricular and subcortical cortical white matter, which has progressed since 2007. Multiple chronic lacunar infarcts are redemonstrated, especially in the left basal ganglia, right external capsule, right cerebellar hemisphere, and pons. There are also numerous scattered foci of susceptibility effect. A slightly larger focus of susceptibility artifact is redemonstrated in the left thalamus. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens replacements. There is a right maxillary sinus probable mucocele that mildly expands the right infundibulum, similar to the CT from 1/12/2014. There is a small left maxillary sinus retention cyst. The skull and scalp soft tissues are grossly unremarkable.
1. No evidence of acute infarct or intracranial mass.2. Findings compatible with chronic small vessel ischemic disease and multiple lacunar infarcts, which have progressed since 2007. 3. Scattered foci of susceptibility artifact are compatible with nonspecific chronic microhemorrhages. A slightly larger focus in the left thalamus also likely relates to a remote hemorrhage, as it was apparent on the MRI from 2007.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.