Left side weakness. There is diffuse high T2 signal swelling in the left inferior cerebellar hemisphere and left posterior medulla with numerous punctate areas of susceptibility effect. There is partial effacement of the inferior fourth ventricle, but no evidence of obstructive hydrocephalus. There are unchanged scattered areas of cerebral and pontine white matter T2 hyperintensity and a small area of encephalomalacia in the superior right frontal gyrus. There is no evidence of new infarcts. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is right osteomeatal unit complex pattern of secretions and mucosal disease, as well as secretions and mucosal thickening in the left sphenoid and left maxillary sinuses. There are bilateral mastoid air cell effusions.
1. Subacute left PICA territory infarct with associated petechial hemorrhage.2. Unchanged probable chronic small vessel ischemic disease involving the brain parenchyma and a small chronic right frontal lobe infarct.3. Scattered paranasal sinus inflammatory disease.