Altered mental status and aphasia. There is a focus of restricted diffusion in the left periventricular corona radiata, but there is also hemosiderin staining in this region raising the possibility of artifactual signal versus true restricted diffusion. There is evidence of the left thalamic hematoma with internal T1 bright signal indicating methemoglobin which overall remains unchanged in size from previous CT. There are punctate foci of hemosiderin staining in the pons indicative of prior chronic hemorrhage without any findings to suggest an acute or subacute component.There are confluent and scattered T2 hyperintensities in the periventricular and subcortical white matter, which may represent small vessel ischemic disease. In addition there are T2 hyperintense foci in the right more than left cerebellum and in the pons. The ventricles and cortical sulcal spaces are prominent compatible with global parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the bilateral maxillary, sphenoid and ethmoid sinuses.The skull and scalp soft tissues are grossly unremarkable.
1. Punctate focus of restricted diffusion in the left periventricular coronal radiata which may reflect ischemia, but there is also strong hemosiderin staining in this area raising the possibility of artifact.2. Evolving left thalamic hematoma without significant change in size.3. Chronic appearing pontine hemorrhage in association with extensive chronic lacunar disease.3. Chronic small vessel ischemic disease elsewhere in the cerebral hemispheres.4. Prominent ventricular system and sulci compatible with global parenchymal volume loss.