 There is no restricted diffusion to suggest acute ischemia. Redemonstrated is extensive encephalomalacia in the right temporal lobe lobe with ex vacuo dilatation of the right lateral ventricle. As before, there are areas of high T2/FLAIR hyperintensity in the subcortical and the periventricular white matter bilaterally consistent with chronic ischemic disease. Chronic lacunar infarcts involving the bilateral corona radiata, as well as the right posterior frontal centrum semiovale are again seen. The ventricles and the sulci are prominent related to volume loss, as before. Punctate susceptibility is seen in the right temporal lobe, suggestive of chronic blood products in the area of previous infarct. There has been some improvement in right maxillary sinus opacification. There is mildly increased mucosal thickening in the left maxillary sinus. Partial left mastoid air cell opacification again seen. Bilateral lens implants.
1. No evidence of acute ischemia.2. Chronic large right temporal lobe infarct again seen. Chronic small vessel ischemic disease with multiple bilateral lacunar infarcts also again seen.