Male 55 years old with intractable epilepsy, cognitive slowing No evidence of diffusion restriction to suggest acute infarction. No evidence of intracranial hemorrhage or mass. Right frontal lobe encephalomalacia appears unchanged from prior exam. Patchy areas of subcortical and periventricular T2/FLAIR hyperintensity, appearing similar to prior exam and suggestive of chronic white matter small vessel ischemic disease. Stable thinning of the corpus callosum. The ventricles and basal cisterns are normal in size and configuration. No midline shift or herniation. The major cerebral flow voids are intact. The sinuses are almost completely opacified with progression noted in the sphenoid. The mastoid sinuses are relatively clear. The orbits, skull, and scalp soft tissues are grossly unremarkable.
1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Right frontal lobe encephalomalacia likely secondary to chronic infarct, unchanged from prior exam. 3. Stable chronic white matter small vessel ischemic disease.4. The sinuses are almost completely opacified with progression noted in the sphenoid.