70-year-old female with altered mental status. Evaluate for stroke or central nervous system infection. The patient has hypertension at baseline and was reported to have had a episode of hypotension prior to presentation. There are multifocal punctate areas of restricted diffusion involving the bilateral MCA territories with the largest in the left centrum semiovale and right frontal lobe. Additional examples of small foci are located in the posterior periventricular parietal regions and right medial cerebellar hemisphere. There are underlying patchy T2 signal abnormalities which are nonspecific but most likely represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass effect, midline shift, hydrocephalus or herniation. The post-contrast sequences are severely limited by motion. Within this limitation, there is no gross abnormal intracranial enhancement. There is diffuse cerebral volume loss. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.
1.Multifocal punctate areas of supratentorial and infratentorial restricted diffusion are compatible with recent watershed infarcts or less likely embolic infarcts.2.Underlying mild degree of chronic small vessel ischemic disease.Findings were discussed with Dr. Browning (pager 1234) by Dr. Veronesi at the time of the finding on 7/8/2016 at 1530.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.