 An area of restricted diffusion is seen in the right deep frontal white matter with somewhat more extensive high T2/FLAIR signal, representing acute ischemia but with probable underlying T2 shine through from more chronic changes. A punctate focus of restricted diffusion in the left superior frontal gyrus demonstrates corresponding high signal on T2 and FLAIR. There is a prominent somewhat linear are of restricted diffusion in the right temporal lobe with T2/FLAIR hyperintensity representing acute ischemia. A focus of mild diffusion hyperintensity and ADC isointensity is also visualized in the left parietal lobe. These findings are consistent with areas of recent ischemia, likely of slightly varying age.In addition, the T2/FLAIR hyperintensities are seen in the basal ganglia, midbrain, pons, cerebellar white matter bilaterally, as well as more extensively in the subcortical and periventricular white matter are consistent with chronic small vessel ischemic changes. There are multiple scattered CSF irregular foci in the white matter consistent with chronic lacunar infarcts.There are multiple scattered foci of susceptibility likely relating to chronic blood products from previous microhemorrhages.Ventricular size is normal with no evidence of midline shift. Basal cisterns are patent. No evidence of herniation. Vascular flow voids are normal.There is opacification of the left sphenoid sinus with inspissated secretions extending to the left ethmoid sinus.
1. Scattered foci of bilateral acute to likely subacute supratentorial infarcts which may be embolic.2. Multiple chronic lacunar infarcts with extensive chronic white matter chronic ischemic changes especially for patient age.3. Multiple foci of susceptibility likely relating to chronic microhemorrhages.