81 years, Female, assess recently seen left internal capsule lesion.. There is a small focus of restricted diffusion involving the left anterior limb of the internal capsule near the genu. There is also a focus of more mildly restricted diffusion with isointense ADC signal involving the right posterior frontal semiovale suspected to represent a subacute infarct. There are additional scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. There is a encephalomalacia in the left occipital lobe consistent with chronic infarct. Additional smaller cortical infarcts are also noted involving the left frontal and right parietal lobes.There is a small, 8 x 5 mm extra-axial enhancing lesion, sagittal postgadolinium series 1101 image 90, along the anterior aspect of the planum sphenoidale, likely representing a meningioma. No intracranial hemorrhage. No intracranial mass-effect. The ventricles are within normal limits in size and configuration for age. There is mild scattered paranasal sinus mucosal thickening with small fluid levels, relatively greater in the left maxillary sinus.Degenerative changes in the partially imaged cervical spine are better assessed on recent CT.
1. Small acute infarct involving the anterior limb of the left internal capsule near the genu. A punctate focus of likely subacute ischemia is also seen in the right posterior frontal centrum semiovale. 2. Additional chronic cortical infarcts are also seen in the left occipital lobe, left frontal lobe and right parietal lobe. There is also a background of mild to moderate chronic small vessel ischemic disease.3. Subcentimeter enhancing lesion along the anterior planum sphenoidale likely represents a meningioma.