Reason: Evaluate for ischemia, etiology of altered mental status History: Altered mental status, L sided weakness, A punctate focus of diffusion restriction is present at the genu of the right internal capsule.There are punctate foci of T2 and flair signal hyperintensity in the basal ganglia, right cerebral peduncle, midbrain, and pons. There are multiple foci of punctate signal hypointensity on susceptibility imaging scattered in the cerebellar hemispheres the brainstem, basal ganglia and thalami as well as some of the subcortical white matter.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Many of the images especially postcontrast images are degraded by patient motion.
1.Acute lacunar infarct is present at the genu of the right internal capsule.2. Findings are compatible with multiple old lacunar infarcts in the basal ganglia and brainstem.3.Multiple old foci of microhemorrhage are present in the posterior fossa and basal ganglia and to a lesser degree subcortical white matter in a distribution which is suggestive of hypertension as an etiology.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Motion artifact may obscure more subtle abnormalities are