 BRAIN: There is diffusion restriction with gyral enhancement involving the left thalamus, left fusiform gyrus, left forceps major, parahippocampal gyrus and left occipital lobe involving the lingual gyrus consistent with subacute infarct. There are additional scattered areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic disease. The ventricles and sulci are prominent, consistent with mild age-related volume loss. No evidence of hemorrhage or significant mass effect. There is no midline shift. No extra-axial fluid collection is identified.ORBITS: The optic nerves are normal in signal intensity. The right optic nerve is slightly asymmetrically smaller than the left. No abnormal enhancement or mass is seen in the orbits. Globes and extraocular muscles are unremarkable. No bone destruction of the orbital walls is seen.
1. Evolving left PCA territory subacute infarction primarily involving the left temporo-occipital lobes and thalamus.2. No abnormal signal involving the optic nerves or orbital lesions. The right optic nerve is slightly smaller than the left which is of uncertain significance. 3. Chronic small vessel ischemic disease. 