Altered mental status. Post heart transplant. Rule out PRES. The multiple chronic cortical infarcts involving the bilateral cerebral hemispheres, with a relatively large region involving the right temporal lobes and the right frontal lobe remain unchanged. The additional T2/FLAIR hyperintensity within the periventricular and subcortical white matter consistent with small vessel ischemic disease is also unchanged, accounting for technique differences. Changes of laminar necrosis and foci of susceptibility effect representing hemosiderin staining or calcification also remain unchanged. The small chronic lacunar infarcts involving the left thalamus, right periatrial white matter, and bilateral cerebellar hemispheres, right greater than left, are unchanged. There is no acute infarct or new intracranial hemorrhage. There is no significant abnormal contrast enhancement. The ventricles and other CSF-containing spaces are unchanged in size, reflecting underlying mild-to-moderate brain volume loss. There is no evidence of intracranial mass effect, midline shift, or herniation. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a small, intermuscular left occipital lipoma, measuring up to 2.4 cm in diameter.
1.Unchanged multiple cortical and lacunar infarcts involving the bilateral cerebral hemispheres and cerebellum as detailed above with no new infarcts or imaging findings of posterior reversible encephalopathy.2.Unchanged laminar necrosis and foci of hemosiderin staining or calcification. No new hemorrhage.3.Incidental small left occipital scalp lipoma.