62 years, Male, Reason: L hemispheric lesion? History: recent syncopal/ possible seizure episode; R hyperreflexia; h/o colon CA. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Extensive patchy foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the brainstem which are compatible with moderate to severe chronic small vessel ischemic disease. Scattered lacunar infarcts are also evident including the centrum semiovale, corona radiata, right anterior putamen, and right subinsular region. Focus of FLAIR signal abnormality in the left thalamus may also be related to prior ischemia. Several scattered foci of susceptibility are compatible with chronic microhemorrhages and in a nonspecific distribution.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues are grossly unremarkable.
1. No evidence of intracranial metastatic disease. No evidence of acute infarct.2. Moderate to severe chronic small vessel ischemic disease.