 There is a subtle focus of apparent diffusion restriction in the anterior aspect of the left thalamus without a correlate on the T2 sequence. There is no restricted diffusion elsewhere. Extensive periventricular and subcortical white matter T2/FLAIR hyperintensity is present throughout the cerebral white matter as well as in the pons likely reflective of advanced chronic small vessel ischemic disease. In particular, there is FLAIR signal abnormality involving the bilateral anterior temporal lobes. Areas of T2 hyperintensity are also evident in the bilateral cerebral hemispheres and vermis. Focal area of encephalomalacia is present in the right external capsule with susceptibility signal compatible with chronic hemorrhagic infarct. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Bilateral maxillary sinus retention cysts, left larger than the right.
1. Subtle focus of apparent diffusion restriction in the left anterior thalamus without a definite correlate on the T2 sequences. This finding may represent a small focus of hyperacute infarct, with artifact a less likely possibility. A follow-up study can be considered for confirmation. There is otherwise no clear evidence of acute infarct in the brain. 2. Extensive periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but favored to represent advanced chronic small vessel ischemic disease. Given the particular signal abnormality involving the bilateral anterior temporal lobes, CADASIL may also be a consideration in the appropriate clinical setting. There is also particular T2/FLAIR signal abnormality involving the bilateral cerebellum which is uncommon with chronic small vessel ischemic disease and therefore this finding and perhaps also component of the brainstem and supratentorial signal abnormality may be related to PRES. Other inflammatory processes/encephalitis can also be considered.3. Chronic hemorrhagic infarct involving the right external capsule.Findings were discussed with APN Stefanie Blummer by phone on 12/22/2016 at 11:05 AM. 