Diagnosis: Other symptoms and signs involving cognitive functions and awarenessClinical question: please eval for structural changes, cvaSigns and Symptoms: cognitive impairment The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a focus of susceptibility effect associated with a T2 and FLAIR signal hyperintensity centered in the right basal ganglia compatible with prior focus of hemorrhage.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR signal hyperintense patchy lesions are also present in the brainstem. Some punctate T2 and FLAIR hyperintense lesions are also present in the cerebellum.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eye lens is thin.
1.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. Additional lesions present in the brainstem and cerebellum are also likely vascular related at this age.2.Findings are compatible with encephalomalacia due to an old hemorrhagic focus centered in the right basal ganglia.3.No evidence for acute cerebral infarction.