57 years Female (DOB:1/2/1959)Reason: re-evaluate for pathologic source of intermittent R hemianopsia History: re-evaluate for pathologic source of intermittent R hemianopsia, probable migraine with aura, hx of stroke 2014 w/ R hemiparesis and slurred speechPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ There is redemonstration of a T2 and FLAIR hyperintense focus located along the right middle frontal gyrus posteriorly measuring approximately 27 x 7 mm axial dimensions involving cortex. This has not changed significantly compared to the prior exam. There are more periventricular and subcortical punctate T2 and FLAIR hyperintense lesions in the periventricular and subcortical white matter compared to the prior exam.There is redemonstration of a small focus of encephalomalacia in the left cerebellar hemisphere. There is an associated focus of signal loss and susceptibility weighted imaging present. Similar smaller lesions are present in the left inferior parietal lobule and left middle frontal gyrus which are new compared to the prior exam.There is no focus of diffusion restriction appreciated brain.There is a focus of susceptibility effect present in the subcortical white matter of the left frontal lobe. As a punctate focus of signal loss and susceptibility weighted imaging the left cerebellar hemisphere. Another punctate focus of signal loss and susceptibility is present in the midbrain anteriorly. Another one is present along the right inferior temporal gyrus. Another couple are present in the left cerebellar hemisphere.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a large mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam there is been accumulation of more periventricular and subcortical white matter lesions. These are nonspecific. Most likely they are vascular related.2.There are multiple microhemorrhages present subcortical white matter as well as in the brainstem and cerebellum3.Cortically based lesion along the right middle frontal gyrus associated with encephalomalacia is also present on the prior exam. It is suspected to be a result of prior vascular event. Similar smaller lesions are present in the left inferior parietal lobule and left middle frontal gyrus which are new compared to the prior exam.