Altered mental status, hypernatremia now corrected. There is a small area of high T2 with slightly restricted diffusion in the periphery of the left cerebellar hemisphere. There is high T1 signal and restricted diffusion along the left transverse and sigmoid sinuses. There is scattered patchy cerebral white matter T2 hyperintensity bilaterally. There are small areas of encephalomalacia in the left basal ganglia and left middle frontal gyrus. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is diffuse mild paranasal sinus mucosal thickening.
1. A small area of high T2 with slightly restricted diffusion in the periphery of the left cerebellar hemisphere likely represents a late subacute infarct.2. High T1 signal and restricted diffusion along the left transverse and sigmoid sinuses may represent subacute venous thrombosis. CT or MR venography may be useful for further evaluation.3. Scattered patchy cerebral white matter T2 hyperintensity bilaterally likely represent chronic small vessel ischemic disease.4. Small chronic infarcts in the left basal ganglia and left middle frontal gyrus.