Altered mental status change and right arm weakness. There is no restricted diffusion to suggest acute infarction. An area of increased T2 signal with volume loss in left thalamus is compatible with a chronic infarct and evolved since prior. There are scattered punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic changes and appear similar to the 5/4/2015 examination. There is no evidence of acute intracranial hemorrhage. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is trace mucosal thickening within the paranasal sinuses as well as trace opacification of the mastoid air cells.
1.No evidence of acute infarction or other acute intracranial abnormality.2.Chronic left thalamic infarct.3.Mild-moderate chronic small vessel ischemic changes.