Confusion and amnesia. Follow-up nonspecific small vessel ischemic disease. The examination is mildly limited by patient motion.There is no acute infarct. Compared to the previous examination, there are 3 new superficial foci of T1/T2-hypointense signal and susceptibility effect involving the medial left frontal lobe, left occipital lobe and superior medial right occipital lobe. These are not associated with surrounding edema. Otherwise, there is unchanged confluent periventricular and scattered subcortical/deep white-matter T2/FLAIR-hyperintense lesions that are nonspecific but probably reflect chronic microvascular ischemia.Mild dilatation of the ventricles and the other CSF-containing spaces, reflecting underlying global parenchymal loss is unchanged. In addition, there is expansion of the subarachnoid space around the left cerebellar hemisphere, which is mildly asymmetrically smaller in size but with decreased interfolial spaces which may reflect a retrocerebellar cyst or an enlarged cisterna magna with mass-effect on the left cerebellar hemisphere. This has not changed since the previous examination. Otherwise, there is no mass-effect, midline shift or brain herniation. There is mild ethmoid mucosal thickening. The right lens has been replaced. The orbits are otherwise grossly unremarkable. There is no destructive skull lesion.
1.Examination is limited by patient motion. There is no acute infarct, mass-effect or midline shift.2.Three microhemorrhages in a cortical/subcortical distribution without associated edema are probably chronic, though new since the January 2016 examination.3.Stable mild chronic microvascular ischemia.4.Stable left retrocerebellar cyst versus mega cisterna magna, with mild mass-effect on the left cerebellar hemisphere.