Male, 57 years old, with altered mental status. Numerous areas of restricted diffusion are redemonstrated involving both cerebral hemispheres and to a lesser degree the cerebellum. As before, the largest lesion occupies the right parietal, occipital and temporal lobes and is associated with patchy T1 hyperintensity.As before, the dominant right parieto-occipito-temporal lesion demonstrates gyriform enhancement while the remaining smaller lesions demonstrate rim enhancement. All lesions are associated with some degree of susceptibility artifact indicating blood product.There has been no significant change in the size or number of these lesions. Associated edema and mass effect, most notably affecting the right parietal and occipital lobes, are unchanged. The right lateral ventricle remains partially effaced.No change is seen in the appearance of intraocular presumed blood product on the right.
There has been no significant interval change in the size, number or morphology of multiple diffusion restricting lesions within both cerebral hemispheres and the cerebellum. As before, these lesions are enhancing and associated with at least microscopic or petechial blood product. These lesions likely reflect an embolic phenomenon, and the possibility that some or most of them represent septic embolic lesions with abscess formation should still be considered.