New onset slurred speech, now resolved, but residual left-sided weakness. There is a punctate focus of mildly restricted diffusion in the posterior limb of the right internal capsule. There is encephalomalacia with hemosiderin staining in the right basal ganglia and corona radiata. There is prominent underlying diffuse low susceptibility signal in the basal ganglia bilaterally, which may represent mineralization. There are a few scattered punctate foci of susceptibility effect in the cerebral hemisphere, which may represent chronic microhemorrhages. There is no evidence of acute intracranial hemorrhage. There is moderate predominantly periventricular white matter T2 hyperintensity without restricted diffusion. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Recent punctate infarction involving the posterior limb of the right internal capsule.2. Evolution of the hemorrhagic infarction involving the right basal ganglia and corona radiata, which is now in the chronic phase.3. Moderate probable chronic small vessel ischemic white matter disease.