History of right IJ (treated in 2014) and left IJ stenosis (untreated), now with generalized weakness and poorly controlled hypertension. There is a new subcentimeter T2 hyperintense lesion in the left thalamus without convincing restricted diffusion. Multiple cerebral white matter T2 hyperintense lesions are otherwise unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses. There are prominent scalp veins.
1. A new subcentimeter T2 hyperintense lesion in the left thalamus without convincing restricted diffusion may represent a late subacute infarct. Otherwise, the probable chronic small vessel ischemic white matter disease and lacunar infarcts appear unchanged.2. Prominent scalp veins may be related to jugular vein stenosis.