Reason: new onset episodes of loss of consciousness in setting of history of stroke and seizures; eval for structural cause History: loss of consciousness. No evidence of true restricted diffusion is seen. Multiple areas of encephalomalacia with surrounding T2 hyperintensity are seen, for example in the left greater than right high frontal lobes, the right inferior occipital lobe, the left anterior temporal lobe and the right lateral cerebellar lobe, compatible with chronic infarcts. These do not appear significantly changed compared to prior CT scan. There is patchy hyperintense signal within the periventricular and frontal white matter on FLAIR, which is consistent with chronic small vessel ischemic disease. There are numerous scattered foci of susceptibility, compatible with old microhemorrhage.The ventricles and sulci are normal in size, with prominent frontal horns, which is unchanged. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Hyperostosis frontalis, as seen on prior CT.
1. Extensive encephalomalacia involving the cerebellum, right occipital lobe, left anterior temporal lobe, and bilateral frontal lobes compatible with multiple prior infarcts. No evidence of acute ischemia, hemorrhage, or intracranial mass. These correspond to the lesions seen on prior CT without interval change.2. Chronic small vessel ischemic disease.