89 years, Female, altered mental status, unable to walk. There are multiple foci of restricted diffusion in the right frontal lobe including the right forceps minor, centrum semiovale and along the cortex of the right superior and middle frontal gyri consistent with acute infarct. Again seen is evidence of multiple prior infarcts including relatively larger areas of encephalomalacia involving the left posterior temporal and occipital lobes, which is new/much larger than prior from 10/20/2004. There is also extensive encephalomalacia involving the right cerebellar hemisphere which has evolved compared to prior study. Multiple chronic infarcts involving the midbrain, pons, left cerebellar hemispheres, basal ganglia and thalami are also noted, some of which were acute at the time of prior study from 2004. There is also more diffuse confluent T2/FLAIR hyperintensity in the periventricular and subcortical white matter which is compatible with chronic small vessel ischemic disease.There are foci of susceptibility compatible with chronic hemorrhage involving the left cerebellar hemisphere parenchyma as well as along the surface of the encephalomalacic right cerebellar hemisphere. No intracranial mass or mass effect. There is global parenchymal volume loss. No hydrocephalus or extra-axial collections. There is ex vacuo dilatation of the left lateral ventricle. Paranasal sinuses and mastoid air cells are grossly clear. Evidence of intraocular lens replacement. Chronic fracture deformity involving the right medial orbital wall better seen on recent CT. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.
1. Several foci of acute infarct involving the right frontal lobe as described above.2. Numerous chronic supratentorial and infratentorial infarcts, some of which were acute at the time of prior study from 10/20/2004.3. Chronic blood products involving the bilateral cerebellar hemispheres.Dr. Ali discussed findings with Dr. Raychaudhuri at 10 am on 8/27/2015.