Blood versus calcification: hyperdensity on CT in setting of hypertensive emergency. There are subcentimeter foci of susceptibility effect in the right basal ganglia and posterior right temporal lobe with surrounding high T2 signal that correspond to the hyperattenuating foci on the recent prior head CT and are new since the brain MRI from 4/8/11. There are multiple other scattered foci of supratentorial and infratentorial susceptibility effect without corresponding hyperattenuation on the recent CT. In addition, there are multiple bilateral basal ganglia and left inferior cerebellar chronic lacunar infarcts superimposed upon a background of predominantly periventricular white matter T2 hyperintensity. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is mild fluid signal in the right mastoid air cells.
Recent microhemorrhages in the right basal ganglia and right temporal lobe superimposed upon a background of chronic hypertensive microhemorrhage and chronic lacunar infarcts, but no evidence of acute infarction.Discussed with Dr. Derani at 11:15 AM on 5/1/15.