Altered mental status. There are multiple unchanged areas of encephalomalacia in the bilateral cerebral hemispheres and right cerebellar hemisphere. There is also a background of scattered patchy cerebral white matter T2 hyperintensity, mainly in a periventricular distribution. There are several scattered punctate foci of susceptibility effect in the bilateral cerebral and cerebellar hemispheres. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is minimal fluid within the bilateral mastoid air cells. There is an unchanged left occipital scalp lipoma.
1. Multiple areas of chronic infarction in the bilateral cerebral hemispheres and right cerebellar hemisphere superimposed upon a background of probable chronic small vessel ischemic disease, but no evidence of acute infarction. 2. Several scattered punctate foci of susceptibility effect in the bilateral cerebral and cerebellar hemispheres may represent chronic microhemorrhages. 