 There is mild diffusion hyperintensity along the left corona radiata and centrum semiovale corresponding ADC isointensity rather than T2 shine through. Other subtle areas of mild diffusion hyperintensity are present in the left frontal and parietal subcortical white matter. There are multiple areas of chronic lacunar infarct, including within the left pons. No MR evidence of acute intracranial hemorrhage. There is susceptibility along the left caudate and basal ganglia.There is extensive encephalomalacia involving the left middle cerebral artery territory including frontal lobe, corona radiata, insula, extending to inferior frontal lobe, and extending to the superior left temporal lobe. There is associated ex vacuo dilatation of the left lateral ventricle. Again noted is a small left frontal extra-axial dural based mass measuring 8 x 6 mm (series 7, image 14), most likely a small meningioma as was previously noted to be calcified on CT, without significant mass effect upon the underlying brain parenchyma. There is nonspecific heterogeneous hypointensity on T2/FLAIR with corresponding blooming on SWI in the right frontal lobe which may represent chronic hemosiderin staining. There is no complete T2 hypointense rim.Prominence of the ventricles and sulci, likely age related volume loss. The cerebellar tonsils are in normal position. Flow voids are present within the major vessels indicating patency, although with diminutive left MCA branches consistent with known area of infarct. The paranasal sinuses and mastoid air cells are clear.
1.Mild diffusion hyperintensity with ADC isointensity scattered along the left corona radiata and centrum semiovale as well as frontal and parietal subcortical white matter upon much more extensive underlying background of chronic small vessel ischemic changes and encephalomalacia in the left MCA territory, suggesting evolving superimposed recent ischemic changes.2.Incidental note is made of the small left frontal dural-based extra-axial mass, most likely a meningioma, without significant mass effect on the underlying brain parenchyma.3. Small area of likely chronic hemosiderin deposition in medial right frontal lobe, not likely felt to relate to an underlying cavernoma.