Seizures with history of ESRD on hemodialysis, lung cancer status post left lower lobe resection, diabetes, sarcoidosis. There are postoperative findings related to right frontal cranioplasty. There is less conspicuous subcortical white matter T2 hypointensity with relative cortical T2 hyperintensity in the right precentral gyrus region. There is diffuse cerebral and pontine white matter T2 hyperintensity, which appears slightly more extensive than previously. There is diffuse cerebral volume loss, which is more pronounced than previously. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.
1. Diffuse cerebral and pontine white matter T2 hyperintensity, which appears slightly more extensive than previously, is nonspecific, but may represent chronic microvascular ischemic disease. Otherwise, no evidence of acute infarction.2. Less conspicuous subcortical white matter T2 hypointensity with relative cortical T2 hyperintensity in the right precentral gyrus region, which may have been related to seizure activity.3. Diffuse cerebral volume loss, which is more pronounced than previously. 4. No evidence of gross intracranial tumor, although the assessment is limited due to the lack of intravenous contrast.