Reason: recent multiple strokes. increased wandering and memory loss. recent 25 lb weight loss. evaluate for new strokes or malignancy History: weight loss There is redemonstration of a large focus of encephalomalacia involving the right parietal lobe. Another focus of encephalomalacia is present along the medial aspect of the right occipital lobe and unchanged compared to the prior exam. A smaller focus of encephalomalacia is present in the right middle and inferior frontal gyri. This is also stable compared to the previous exam. A smaller focus of encephalomalacia is present along the posterior aspect of the right superior frontal gyrus. This is also stable compared to the previous exam.No foci of diffusion restriction are appreciated on the current exam.The punctate focus of high signal on T2 and flair MRI is present in the right cerebral hemisphere which is new since the prior exam. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small parafalcine focus of susceptibility which is bright on T1 imaging measuring 17 x 6 mm axial dimensions and 17 x 12 mm sagittal dimensions. It is located adjacent to the right cingulate sulcus.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Multiple foci of encephalomalacia in the right hemisphere compatible prior vascular insults are stable compared to the previous exam.2.There is a small hemorrhagic focus present adjacent to the falx cerebri which is suspected to be in the subacute stage.3.Findings were discussed with Dr Neda Laiterapong