Altered mental status. Therapeutic on coumadin. Evaluate for progression of septic emboli. There are multiple punctate foci of restricted diffusion with high T2 signal scattered throughout the cerebral and cerebellar white matter, involving watershed territories and subcortical white matter, which are decreased slightly in number from prior MRI. There are no new foci of restricted diffusion. There is a foci of susceptibility within the left corona radiata, new from prior, compatible with microhemorrhage. Additional focus of microhemorrhage within the left basal ganglia is unchanged. There is no evidence of mass. There is no midline shift or herniation. There is mild diffuse cerebral volume loss. The major cerebral flow voids are intact. Fluid is retained within the bilateral mastoid air cells, unchanged. The paranasal sinuses are otherwise clear. The orbits, skull, and scalp soft tissues are grossly unremarkable.
1.Evaluation is limited due to motion degradation. Multiple punctate foci of cerebral and cerebellar acute ischemia bilaterally, decreased in number from prior studies, related to resolving embolic infarctions. New microhemorrhage within the left corona radiata, at site of prior infarct.2.Nonspecific bilateral tympanomastoid effusions.