57-year-old male with altered mental status, history of stroke, assess for acute stroke There is no restricted diffusion to suggest the presence of acute ischemia. A tiny foci posteriorly in a left paramedian location demonstrating apparent DWI hyperintensity (image 200, series 306) lies outside the brain parenchyma is felt to be related to underlying vascularity and prominent venous lake.Redemonstrated are multifocal susceptibility artifacts without surrounding edema on bilateral hemispheres, basal ganglia, brain stem and especially on the left side midbrain indicating prior hemorrhagic foci and chronic petechial parenchymal hemorrhages, as well as involving the cerebellum. There is been no interval change since prior scan. Redemonstrated is extensive T2 hyperintensity within the periventricular white matter and centrum semiovale bilaterally indicating advanced nonspecific small vessel ischemic disease. Similar T2 hyperintensity is also noted within the thalami, pons, medulla, left cerebellum. There is been no interval change since prior scan. The ventricles, sulci and cisterns are prominent which could be related to volume loss, which is stable in appearance. There is no mass, mass effect, or midline shift. Normal flow voids are identified in the major intracranial vessels. Fluid is noted within a few right mastoid air cells. The paranasal sinuses and left mastoid air cells are clear.
1.There is no restricted diffusion to suggest the presence of acute ischemia.2.No change of multifocal susceptibility artifacts as well as extensive non specific white matter lesions.3.Fluid is noted within a few right mastoid air cells. 