Male 55 years old with Hx of new onset left arm weakness with extensor predominance and hand numbness, please evaluate for infarcts Mild periventricular and subcortical T2/FLAIR hyperintensities suggestive of chronic small vessel ischemic changes, several of which demonstrate focal volume loss within the bilateral frontal periventricular white matter, basal ganglia, and right pons. Some of these lesions are also associated with susceptibility, indicative of chronic microhemorrhages, and appear similar to prior exam. There is no evidence of acute intracranial hemorrhage, mass, or restricted diffusion to suggest ischemia. Stable mild global parenchymal volume loss. The ventricles and basal cisterns are patent. There is no midline shift or herniation. The major cerebral flow voids are intact. Right maxillary retention cyst appearing stable from prior exam. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. No evidence of acute infarct or intracranial mass effect.2. Chronic small vessel ischemic disease with multiple chronic lacunar infarcts within the bilateral periventricular white matter, basal ganglia, and right pons appear similar to prior. Scattered chronic microhemorrhages also appear similar to prior. 