79-year-old male with waxing and waning altered mental status. Please note that mild motion artifact limits evaluation. Focus of increased DWI signal in the left posterior frontal lobe likely represents artifact from susceptibility in this area. No definite evidence of diffusion restriction to suggest infarct. Severe enlargement of the ventricles and sulci likely reflects atrophy. Moderate to severe periventricular and subcortical T2 hyperintensities are nonspecific but likely represent chronic small vessel ischemic disease. Focus of susceptibility in the left high convexity is likely related to chronic hemosiderin deposition. A few additional punctate foci of susceptibility are present which are nonspecific. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild mucosal thickening of the bilateral maxillary sinuses with a left maxillary mucous retention cyst/polyp.
Moderate to severe chronic small vessel ischemic disease. No acute infarct.