Female, 70 years old, with history of stroke and dementia with worsening memory loss. Extensive confluent periventricular white matter T2 hyperintensity is redemonstrated appearing similar to the prior examination. Numerous additional scattered more discrete foci of parenchymal T2 hyperintensity are also redemonstrated including within the pons, unchanged. No restricted diffusion is seen.There is no evidence of parenchymal edema or mass effect. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Multiple scattered foci of susceptibility artifact are seen in the cerebral hemispheres, the thalami on the brainstem suggesting chronic microhemorrhage. No pathologic parenchymal or extra axial enhancement is observed. The cerebral sulci and the ventricles are mildly and proportionately prominent suggesting some degree of underlying parenchymal volume loss.
1.Findings are seen compatible with extensive chronic microvascular ischemic disease.2.Multiple scattered foci of microhemorrhage are also seen which may relate to small vessel ischemic disease though amyloid angiopathy can present similarly.3.A mild degree of generalized cerebral volume loss is demonstrated.4.No acute intracranial abnormalities.