 MRI BRAIN: There is a thin rim of cortically located diffusion weighted abnormality with associated FLAIR abnormality within the right occipital lobe. There is also subtle cortical T1 hyperintensity and susceptibility in this region suggesting laminar necrosis. There is also a small focus of mild restricted diffusion involving the superolateral cerebellar hemisphere, which likely represents an additional tiny acute/subacute infarct.Encephalomalacia is seen in the right frontal and parietal operculum, right insular cortex, inferior frontal lobe, left centrum semiovale, posterior limb of the left internal capsule, left occipital lobe and left cerebellum, indicating prior infarcts. There is evidence of additional small chronic infarcts involving the left pons and left medulla which were also present previously. There is unchanged moderate periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. There is no hydrocephalus, midline shift or herniation. There is opacification of the left maxillary sinus, left anterior ethmoid air cells and left frontal sinus which suggests left ostiomeatal unit obstruction.
1.Small subacute cortical infarct involving the right occipital lobe and a small acute to subacute right cerebellar infarct.2.Multiple chronic supra and infratentorial infarcts as described above.3.Moderate chronic small vessel ischemic disease.4.Opacification of the left maxillary sinus, left anterior ethmoid air cells and left frontal sinus which suggests left ostiomeatal unit obstruction.