Reason: stroke workup in patient with history of stroke presenting with worsening dysarthria and new onset dysphagia and ataxia. Mild asymmetry of the ventricles is again noted, felt to be within normal limits of anatomic variation, and unchanged. The basal cisterns remain patent. There is no midline shift or mass effect. There is mild volume loss involving the cerebellum. There are scattered punctate foci of increased T2/FLAIR signal within the periventricular white matter which are nonspecific and appear similar to the 4/9/2015 examination. There is also curvilinear focus of increased T2 signal within the left lower pons compatible with chronic infarction corresponding to the area of restricted diffusion seen on the 4/9/2015 examination. Previously seen increased T2 signal involving the middle cerebellar peduncles has improved, consistent with evolution of prior injury. There are numerous punctate foci of susceptibility in both the supratentorial and infratentorial compartments in a nonspecific distribution. Although some of these foci appear slightly more prominent or apparently new compared to the prior examination, this may at least in part reflect increased sensitivity of the technique. In the setting of renal insufficiency, these may reflect hemolytic microangiopathy. No pathological enhancement is identified. There is no diffusion abnormality currently. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The skull and scalp soft tissues are grossly unremarkable. There is mild patchy opacification of the paranasal sinuses. There is again volume loss and abnormal signal involving the left globe compatible with phthisis bulbi. Additional abnormal signal involving the right globe as seen on the prior studies is consistent with prior intraocular detachment.
1.No evidence of acute infarct.2.Chronic infarction involving the left pons. Additional nonspecific supratentorial white matter signal abnormality appearing similar to prior and favored to reflect chronic small vessel ischemic changes.3.Again seen are numerous foci of susceptibility compatible with chronic microhemorrhages. These are nonspecific but may reflect hemolytic microangiopathy in this patient with renal insufficiency.