Word finding difficulty. Evaluate for acute ischemia. There is a punctate focus of restricted diffusion within the left superior parietal lobule. There is no mass effect, midline shift or herniation. There are multiple punctate foci of susceptibility abnormality predominantly involving the basal ganglia, claustrum, thalami, and inferior cerebellum bilaterally, as well as the right centrum semiovale, right occipital lobe and left medial frontal lobe compatible with blood product from microhemorrhage. There is encephalomalacia likely in the right frontal lobe including the centrum semiovale, corona radiata, insula, and subinsular white matter with ex vacuo dilatation of the right lateral ventricle. There is also encephalomalacia in the right cerebellar hemisphere. There are additional scattered areas of T2 hyperintensity in the periventricular and subcortical white matter. There is diffuse cerebral volume loss with superimposed Wallerian degenerative of the right brainstem. There is minimal mucosal thickening involving the right anterior ethmoid air cells. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a punctate focus of T1 and T2 hyperintensity in the right parietal calvarium, which likely represents a hemangioma.
1.Punctate acute infarct in the left parietal lobe without hemorrhagic transformation.2.Multiple punctate foci of susceptibility likely represent chronic microhemorrhages related to hypertensive.3.Chronic infarcts involving the right frontal lobe, insula, and right cerebellar hemisphere.4.Chronic patchy periventricular and subcortical small vessel ischemic disease.