 There is redemonstration of small focus of evolving restricted diffusion in the right inferior parietal lobe, that measures 12 mm and a punctate lesion of restricted diffusion in the left inferior parietal lobe. Additional focus of restricted diffusion is also visualized within the subcortical white matter of the right pre-cuneus and within the pons. These foci are unchanged since the previous study and are associated with hyperintensity in the T2/FLAIR sequences.. There are no new foci of restricted diffusion.There are T2/FLAIR hyperintensities in the pons and in the right middle cerebral peduncle with no restricted diffusion, unchanged since the previous study. There are punctate foci of T2/FLAIR hyperintensities in the periventricular and subcortical white matter representing chronic small vessel ischemic changes.Again noted diffuse punctate susceptibility signals throughout the brain, likely representing hemosiderin deposition. The pattern is suggestive of amyloid angiopathy.There is diffuse leptomeningeal FLAIR hyperintensity which may suggest meningoencephalitis, encephalitis, or vasculitis.Ventricular size is stable. No evidence of acute hemorrhage. Basal cisterns are patent. The T2 flow-voids are unremarkable.There is diffuse edema in the visualized cervical spinal cord.There is mucosal thickening in the maxillary sinuses and opacities in the mastoid air cells, most likely due to the patient being intubated.
1.A small focus of infarction in the right inferior parietal lobule and microinfarcts in the right and left parietal lobes are stable and compared to the prior exam.2.Findings suggest a leptomeningeal disease. Differential considerations include meningoencephalitis, encephalitis, or vasculitis.3.Diffuse edema in the visualized spinal cord extends to the lower medulla.4.Multiple microhemorrhages are identified in subcortical white matter with a pattern of distribution suggestive of amyloid angiopathy.