64 years, Male, new onset seizure. Examination is limited due to motion degradation and limited sequences could be obtained. There is however no evidence of intracranial mass or mass effect. There is extensive confluent T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter most compatible with advanced chronic small vessel ischemic disease. Multiple bilateral lacunar infarcts are noted including the pons bilaterally, left thalamus, as well as the left frontal corona radiata. Volume loss also noted in the left basal ganglia with ex vacuo dilatation of the left frontal horn, also likely sequela of chronic infarct. There is possible focus of diffusion restriction involving the posterior limb of the left internal capsule which may represent a recent infarct. There is global parenchymal volume loss which is advanced for patient's age. No hydrocephalus. No extra-axial collections. No midline shift or herniation. There is mild scattered paranasal sinus opacification. There is also partial opacification of the mastoid air cells, right relatively greater than left. Phthisis bulbi on the left.
Limited exam as described in the technique and findings. There is no intracranial mass or mass effect. There is evidence of advanced chronic small vessel ischemic disease with multiple chronic supra and infratentorial lacunar infarcts. There is possible focus of restricted diffusion involving the posterior limb of the left internal capsule raising possibility of a recent infarct, although given the aforementioned limitations, artifact remains a possibility.