Worsening mental status, aphasia, and right hemiparesis. Several sequences are degraded by motion.There is restricted diffusion involving the anterior and lateral aspects of the left thalamus as well as an additional punctate focus within the splenium of the left corpus callosum with associated increased T2 signal compatible with acute/subacute ischemic infarctions. There is also mild associated swelling of the left thalamus without associated significant mass effect, although there is mild convexity of its medial margin. Susceptibility weighted images are significantly degraded by motion but demonstrate punctate foci of susceptibility artifact in the bilateral deep gray nuclei as well as within the right temporal occipital region which are compatible with microhemorrhages and which are favored to be chronic, however, recent petechial hemorrhage is not entirely excluded. There is encephalomalacia involving the medial aspect of the left occipital lobe compatible with chronic infarction. Confluent areas of increased T2/FLAIR signal within the periventricular white matter, basal ganglia, and brainstem are nonspecific but compatible with chronic small vessel changes. The ventricles and sulci are within normal limits for age. The basal cisterns remain patent. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits.There is dilation of the left horizontal portion of the cavernous internal carotid artery which bulges into the cavernous sinus and left middle cranial fossa as characterized on recent CTA. The occlusion of the left posterior cerebral artery is better visualized on recent CTA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Acute/subacute infarction involving the left thalamus with additional punctate acute/subacute infarct involving the left splenium of the corpus callosum.2.Chronic left occipital lobe infarction.3.Occlusion of the left posterior cerebral artery as well as left cavernous internal carotid artery fusiform aneurysm more fully characterized on CTA from 8/18/2016.4.Moderate chronic small vessel ischemic changes.5.Scattered punctate foci of susceptibility artifact compatible with microhemorrhages, favor chronic though recent petechial hemorrhage associated with left thalamic infarction is not entirely excluded.