Altered mental status and reported CVA at outside hospital 2 weeks ago No restricted diffusion to indicate acute ischemia.There is extensive periventricular and subcortical white matter increased T2 signal which becomes confluent superiorly and posteriorly. Statistically this most likely represents extensive chronic small vessel ischemic changes. There are multiple small areas of susceptibility in the left parietal lobe likely microhemorrhages. The small focus of increased density on prior CT in the right caudothalamic groove also has susceptibility artifact and punctate increased T1 and T2 signal suggestive of a subacute microhemorrhage.No abnormal enhancement within the limits of a motion degraded exam. There is no evidence of intracranial hemorrhage, mass or edema. Generalized cerebral volume loss with prominence of the ventricles and sulci. The expected intracranial vascular flow voids are present.Mild left maxillary sinus mucosal thickening. The visualized mastoid air cells are clear. The orbits are unremarkable.
1. No acute ischemic infarct.2. Extensive subcortical and periventricular white matter T2 signal abnormality compatible with extensive chronic small vessel ischemic disease.3. Possible subacute microhemorrhage in the right caudothalamic groove with additional chronic microhemorrhages in the left parietal lobe.