80 years, Female, altered mental status. Evaluate for etiology of mental status decline. There is moderate degree of restricted diffusion involving the right frontal and anterior parietal lobes including the cortex and subcortical white matter with corresponding FLAIR hyperintensity and is new since 4/23/2015. There is extensive confluent T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which is otherwise similar to prior. Encephalomalacia involving the right parietal lobe posteriorly is unchanged. Extensive encephalomalacia involving the left basal ganglia with FLAIR hyperintensity extending into the subinsular white matter and left thalamus is also unchanged. There is FLAIR hyperintensity extending along the left corticospinal tracts which is similar to prior and consistent with Wallerian degeneration. There is extensive enhancement involving the right frontoparietal cortex corresponding to the region of restricted diffusion and extending into the subcortical and deep white matter, new since prior.There is ex vacuo dilatation, particularly of the left lateral ventricle without evidence of hydrocephalus. Multiple foci of susceptibility effect including the left frontal lobe, left temporal lobe, and left parietal lobe are unchanged and consistent with chronic microhemorrhages. No intracranial mass or mass effect. No extra-axial collections. Major arterial flow-voids are present. Bone marrow signal and extracranial soft tissues are grossly unremarkable.
1. Late acute to subacute infarct involving the right frontal and right parietal lobes.2. Advanced chronic small vessel ischemic disease and multiple chronic infarcts including the right posterior parietal lobe and the left basal ganglia. Evidence of Wallerian degeneration along the left corticospinal tract. Unchanged scattered chronic microhemorrhages, which may be related to amyloid angiopathy but nonspecific.Dr. Ali discussed findings with Dr. Tang at 1350 hours on 8/26/2015.