Female, 70 years old, with history of stroke and residual deficits (expressive aphasia, left-sided weakness), now with worsening mental status, unable to respond to questions or simple commands. Concern for new stroke. Image quality is degraded by significant motion artifact. Within this limitation, the following observations are made.Large areas of encephalomalacia are redemonstrated involving the left parietal, occipital and temporal lobes, and the right middle frontal gyrus. These lesions appear similar to the prior MRI. Encephalomalacia in the right occipital lobe is new from the prior MRI but unchanged relative to a CT from 2012. Numerous small, chronic cerebellar infarcts are also unchanged. No evidence of restricted diffusion is seen to suggest acute ischemia.Ill-defined periventricular T2 hyperintensity has progressed from the prior examination. Ventricles and sulci are prominent compatible with volume loss. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.
1.Evidence of extensive bilateral chronic ischemia is seen, largely within the MCA distributions, showing no significant change from prior exams.2.Findings compatible with moderate chronic microvascular ischemic disease have progressed from prior.3.No evidence of acute ischemia or any other definite acute intracranial abnormality. No new findings are seen which would account for the patient's symptoms.