 There are multiple, asymmetric areas of patchy T2/FLAIR hyperintensity in the subcortical white matter of the bilateral frontal, temporal and parietal lobes, relatively more prominent in the left frontal lobe, and without significant interval change from 2008. There is slightly interval progression of supratentorial and infratentorial parenchymal volume loss, including more focal areas of volume loss in the right lateral cerebellum, which may be related to prior ischemia. No evidence of intracranial hemorrhage or acute infarction. There are no extra-axial fluid collections or subdural hematomas. No evidence of intracranial mass, mass effect, or midline shift. There is no abnormal enhancement within the brain. The ventricles and sulci are otherwise normal in size. Flow-voids are present within the major vessels indicating patency. There is mild mucosal thickening of the right maxillary sinus. Calvarium and extracranial soft tissues are grossly unremarkable.
1. No evidence of intracranial metastatic disease.2. Multiple patchy areas of white matter T2/FLAIR signal abnormality in the bilateral cerebral hemispheres remains unchanged since 8/21/2008. The differential diagnosis remains broad, and includes prior inflammation, demyelination, ischemia or other injury.