Dementia. There are small areas of encephalomalacia in the bilateral basal ganglia and cerebellar hemispheres. There is scattered cerebral white matter T2 hyperintensity as well. In addition, there are numerous scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres, basal ganglia, and pons. There is mild diffuse cerebral volume loss. There appears to be a defect in a portion of the septum pellucidum. There is no evidence of intracranial mass or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Probable chronic lacunar infarcts in the bilateral basal ganglia and cerebellar hemispheres, chronic small vessel ischemic white matter disease, probable chronic hypertensive microhemorrhages, as well as mild diffuse cerebral volume loss, but no evidence of acute infarct.