Male, 75 years old, with encephalopathy. Follow-up for prior read of possible PRES. The previously seen focus of restricted diffusion within the right parietal white matter is still visible though it is less intense and less distinct. However, there is a new focus of diffusion hyperintense signal in the right frontal subcortical white matter. Curvilinear diffusion hyperintense signal along the margin of the left thalamus is of questionable validity.Fairly extensive confluent periventricular T2 hyperintensity without mass effect is again seen, appearing similar to the prior examination. Vague signal abnormality is also demonstrated in the brain stem and cerebellum, similar to prior. Again seen are scattered chronic lacunar infarcts within the basal ganglia and thalami bilaterally.Multiple scattered punctate foci of susceptibility effect are seen in the cerebral hemispheres, particularly in the basal ganglia and medial thalami, brainstem and cerebellum. Most or all of these are accounted for on the prior examination though they are better seen on the present study likely due to imaging at 3T. No evidence of acute intracranial hemorrhage is seen. No abnormal extra-axial fluid collections are detected.
1.A focus of acute ischemia seen previously in the right parietal lobe appears less distinct compatible with expected evolution.2.A new focus of acute ischemia is suspected within the right frontal subcortical white matter. Curvilinear diffusion hyperintense signal along the left thalamus is of questionable validity and could be artifactual.3.Extensive T2 hyperintense white matter lesions are again seen without significant interval change from the prior examination. No evidence of any significant associated edema or mass effect is seen which would argue against an ongoing acute process.4.Numerous scattered foci of microhemorrhage are also unchanged from the prior exam. No acute intracranial hemorrhage is seen.