 Again seen are remote postsurgical changes of suboccipital craniectomy and encephalomalacia involving the bilateral medial cerebellar hemispheres. Previously seen acute infarct involving the left cerebellum on 9/1/2015 MRI has evolved with increased gliosis involving the left cerebellar vermis and hemisphere. There is new restricted diffusion involving the right cerebellar vermis suspicious for acute infarct with susceptibility artifact related to postsurgical changes limiting evaluation of this region. No associated mass effect or evidence of hemorrhage within the limitations of artifact.Elsewhere in the brain, there is no evidence of intracranial mass or mass effect. There is global parenchymal volume loss similar to prior. There is encephalomalacia involving the right superior frontal gyrus as seen before. There is also evidence of prior right anterior parietal burr hole placement. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with mild chronic small vessel ischemic disease. There is ex vacuo dilatation of the frontal horns, right greater than left. No hydrocephalus. There is moderate opacification of the right maxillary sinus similar to prior. Bilateral lens implants are noted. MRA HEAD
1. Acute infarct involving the right cerebellar vermis. Evolution of previously seen left cerebellar infarct and extensive encephalomalacia involving the bilateral medial aspect of the bilateral cerebellar hemispheres. Postsurgical changes in the posterior fossa again seen.2. Encephalomalacia involving the right frontal lobe again seen. Mild chronic small vessel ischemic disease.3. No high-grade stenosis or occlusion involving the major intracranial vasculature within the limitations of motion degraded study. Note MRA neck with gadolinium was not performed as patient could not tolerate further imaging.Dr. Ali discussed findings with Dr. Raychaudhuri at 1410 hours on 3/29/2016.