Male, 66 years old, with altered mental status, status post corrected hyponatremia, assess for demyelination. Patchy, nearly confluent periventricular T2 hyperintensity is again seen without significant interval change from prior. Scattered foci of signal abnormality are also redemonstrated within the left thalamus and pons without significant interval change. Chronic lacunar infarcts in the bilateral basal ganglia are likewise unchanged.No restricted diffusion, parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. Mild ex vacuo dilatation of the frontal horns is noted. Otherwise, the ventricular system is unremarkable. A large left frontal scalp lipoma is unchanged.
1.No acute abnormality or any significant interval change is seen.2.Extensive periventricular white matter signal abnormality is favored to represent chronic microvascular ischemic disease, given the evidence of multiple prior basal ganglia lacunar infarcts.3.As before, no specific findings are seen to suggest osmotic demyelination.