78-year-old woman with history of endocarditis following cardiac valvular repair, evaluate for emboli. The previously seen, punctate foci of diffusion restriction have resolved and, at these locations, there is minimal residual T2/FLAIR hyperintensity. There is no restricted diffusion to suggest acute ischemia or cerebrovascular embolic disease. There is no abnormal parenchymal or meningeal enhancement. There is no intracranial hemorrhage. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Extensive patchy T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter has not appreciably changed and is nonspecific but compatible with chronic small vessel ischemic changes. There is associated global parenchymal volume loss. Scattered, punctate foci of susceptibility artifact are noted, likely prior microhemorrhages or mineralization. The major flow-voids are preserved. Incidentally noted partially empty sella. The orbits, paranasal sinuses, skull, and overlying scalp are otherwise unremarkable.
1.Resolution of previously seen punctate infarcts without evidence of acute infarcts or abscesses.2.Extensive signal abnormality in the bilateral subcortical and periventricular white matter with volume loss, not appreciably changed and compatible with chronic small vessel ischemic changes.