 The previously demonstrated focus of restricted diffusion in the left corona radiata has resolved. The focus along the right posterior body of the corpus callosum has decreased in conspicuity. There may be subtle FLAIR hyperintensity in these locations. In addition, there is stable minimal nodularity along the left lateral atrial margin, also without corresponding enhancement or susceptibility (1101/80). Diffusion-weighted images do not demonstrate T2 shine through in this location. There are numerous foci of punctate susceptibility scattered throughout the brain parenchyma, most conspicuous along the right greater than left temporal and right occipital lobes peripherally, which are unchanged indicating prior microscopic hemorrhage.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Extensive patchy abnormal T2/FLAIR hyperintensity is again seen throughout the periventricular and subcortical white matter, including anterior temporal tips, as well as the brainstem. Evidence of chronic lacunar infarcts are present along the basal ganglia bilaterally. No extra-axial fluid collection is identified.The right vertebral artery flow-void remains absent. Normal flow-voids are otherwise demonstrated in the major intracranial vascular structures. Incidental partially empty sella is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening throughout the paranasal sinuses. There is at least moderate narrowing of the upper cervical spinal canal
1.No evidence of acute infarct. Normalized diffusion restriction in the left corona radiata and reduced diffusion hyperintensity in the right corpus callosum since 10/27/2016. 2.Persistent minimal nodularity along the left lateral atrial margin that demonstrates gray matter signal on all sequences may represent a small area of subependymal heterotopia.3.Redemonstration of extensive white matter disease with multiple areas of prominent chronic lacunar infarct. Findings again may represent advanced small vessel ischemic changes, although other possibilities such as CADASIL remain within the differential.