79 years, Female, memory impairment, increasing dementia. No restricted diffusion to suggest acute ischemia. There is chronic infarct involving the left MCA territory primarily involving the left middle and inferior frontal gyri, which was seen on prior study from 2013 with interval evolution. There is susceptibility effect within this region which may be related to small amount of chronic blood products and/or mineralization. Additional chronic cortical bilateral occipital infarcts are again seen. There is a chronic appearing left parietal infarct which was not present previously. There is encephalomalacia involving the right inferior temporal lobe, predominantly involving the fusiform gyrus, which may also be related to prior ischemia versus other injury and present previously. There is associated ex vacuo dilatation of the right temporal horn which is unchanged. There is also suggestion of a small right cerebellar infarct not clearly evident on prior study. Scattered foci of T2/FLAIR hyperintensity are also seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and similar to prior. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. Global parenchymal volume loss is again evident and appropriate for patient's age. No disproportional volume loss involving the hippocampi. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Mild mucosal thickening involving the right maxillary, right sphenoid, and bilateral anterior ethmoid sinuses. Calvarium and extracranial soft tissues are grossly unremarkable.
1. Multiple cortical infarcts in the bilateral cerebral hemispheres are again seen. A left parietal lobe infarct and small right cerebellar infarct appear chronic but are new since 5/3/2013. 2. No intracranial mass or mass effect. No hydrocephalus. Global parenchymal volume loss appears age-appropriate.