Acute onset of facial droop and slurred speech. There are new punctate foci of restricted diffusion involving the right frontal centrum semiovale in a linear distribution. There is extensive encephalomalacia in the right posterior cerebral artery territory involving the occipital lobe and medial temporal lobe. There are patchy areas as well as scattered foci of T2 hyperintensity in the bilateral subcortical and periventricular white matter. There are chronic right pontine lacunar and right inferior cerebellum lacunar infracts. There is susceptibility effect indicative of hemosiderin staining along the right posterior cerebral artery territory and right inferior cerebellar infarcts. Additional punctate foci of susceptibility effect compatible chronic microhemorrhages in the cerebellum are also present. There is volume loss with surrounding T2 hyperintensity in the anterior and medial temporal lobes is noted with ex vacuo dilatation of the temporal horns. There is no intracranial mass or mass effect. There are several scattered foci of low signal involving the calvarium such as in the left parietal and right frontal regions and the left sphenoid triangle.
1. New punctate foci of restricted diffusion involving the right frontal centrum semiovale in a watershed distribution.2. Multiple supratentorial and infratentorial chronic infarcts, foci of chronic microhemorrhage in the bilateral cerebellar hemispheres, and a background of chronic small vessel ischemic disease may be related to chronic hypertension.3. Disproportionate volume loss involving the bilateral anterior and medial temporal lobes, which may indicate underlying Altheimer disease. 4. Multiple small area of signal abnormality involving the calvarial bone marrow with recent CT demonstrating multiple sclerotic foci, which may represent sclerotic metastases. Follow up with bone scan or a contrast-enhanced MRI may be useful.Urgent findings discussed with Dr. Bickley on 6/18/2015 at 4:50pm.