Altered mental status and possible right-sided weakness. There are few T2-hyperintense, diffusion-restricted lesions in the left cerebral white-matter, the largest of which involve the subcortical left parietal white-matter and measures up to 8 mm. A smaller subcortical diffusion-restricted lesion involves the left precentral gyrus and may account for patient symptoms. There is at least one additional small focus of diffusion restriction involving the right frontal lobe. Foci of susceptibility effect are also present in some of the these diffusion-restricted lesions in addition to bilaterally in the deep gray nuclei regions. There is no territorial cortical diffusion restriction. The ventricles and the other CSF-containing spaces are minimally enlarged, reflecting underlying mild brain volume loss. There is no mass-effect, midline shift or brain herniation. Linear, nonanatomic T2-hyperintense signal overlying the left prior to occipital region relates to artifact.There is no destructive skull lesion. The orbits are grossly unremarkable. There is fluid signal in both mastoid air cells. There is fluid and mucosal thickening in the sphenoid sinuses.
1.Small foci of white-matter diffusion restriction are present in the left cerebral hemisphere, with one involving the precentral gyrus and probably accounting for patient's symptoms, and are compatible with acute infarcts. There is at least one additional lesion on the right side, in the right frontal lobe. Punctate hemorrhages are present in some of these lesions. The distribution of the lesions is non-territorial and may reflect tiny emboli or, less likely, watershed infarcts from hypoperfusion.2.The foci of susceptibility artifact involving the the deep gray nuclei regions bilaterally may represent hemosiderin staining, for example from chronic hypertension, or mineral deposition/calcifications. Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Parita Patel over the phone on 3/30/2016 9:34 AM.