 There are several scattered foci of restricted diffusion within the paramedian right frontal lobe, right cingulate gyrus, and corpus callosum, which are similar in extent, although the associated T2 hyperintensity is generally now more conspicuous and the degree of diffusion restriction has diminished. There is otherwise an unchanged background of patchy and confluent areas of predominantly periventricular white matter T2 hyperintensity bilaterally and several chronic lacunar infarcts in the bilateral basal ganglia and right pons. There are punctate foci of susceptibility effect along the distal right anterior cerebral artery. There are otherwise unchanged punctate foci of susceptibility artifact in the basal ganglia lacunar infarcts right pons, and left frontal and temporal lobes. The ventricles and sulci are unchanged, including ex vacuo dilatation of the left lateral ventricle. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Interval evolution of areas of recent infarction in the right anterior cerebral artery territory and watershed zone with the middle cerebral artery, without hemorrhagic transformation or midline shift. Punctate foci of susceptibility effect along the distal right anterior cerebral artery likely represent thromboemboli responsible for this recent ischemic event.2. Unchanged background of chronic white matter microvascular disease and lacunar infarcts, some of which are associated with chronic microhemorrhages.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.