62 years, Male, new left arm weakness with hyperreflexia. There are multiple scattered punctate foci of restricted diffusion involving the bilateral cerebral hemispheres consistent with acute infarcts. Some of these are located near the gray-white junction in the right frontal lobe as well as several involving the deep white matter. Single punctate focus within the right globus pallidus is also seen. There are multiple foci of susceptibility in the brain consistent with chronic microhemorrhages. There are relatively larger foci of susceptibility involving the right basal ganglia and left thalamus. Few foci in a peripheral distribution are noted in the paramedian parietal distribution with greater distribution of these foci involving the pons, bilateral cerebellar hemispheres, and basal ganglia; distribution most compatible with chronic hypertension. There is confluent T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter with more focal lacunar infarcts noted in the basal ganglia and left temporal periventricular white matter.There is no evidence of intracranial mass or mass effect or abnormal enhancement to suggest metastatic disease. There is global parenchymal volume loss which is prominent for age. No hydrocephalus. No extra-axial collections. There is mild opacification of the paranasal sinuses. Bone marrow signal and extracranial soft tissues are unremarkable.
1. Multiple scattered punctate foci of restricted diffusion in the bilateral cerebral hemispheres consistent with acute infarcts.2. Advanced chronic small vessel ischemic disease with multiple chronic lacunar infarcts. Multiple foci of chronic microhemorrhage are also seen with distribution favoring a chronic hypertensive etiology.3. No findings to suggest intracranial metastatic disease.Dr. Ali discussed findings with Dr. Kim (MICU) at 1340 hours on 8/4/2015