 There are multiple new foci of restricted diffusion with matching ADC hypointensity throughout both bilateral supratentorial and infratentorial vascular territories. Given the known history of endocarditis, this is most consistent with multiple small embolic infarctions. These have correlated to T2 hyperintensity but no susceptibility abnormality.Redemonstrated are patchy areas of T2 FLAIR hyperintensities in the subcortical and the periventricular white matter and in the pons, which are nonspecific, but most consistent with chronic small vessel ischemic changes. There is a small chronic infarct involving the left precentral gyrus that was seen in the previous study of 5/12/2015. Ventricular size is normal. No midline shift. The basal cisterns are patent. No evidence for acute intracranial hemorrhage, mass effect, or edema.Incidentally noted small lipoma in the left periorbital scalp. Visualized paranasal sinuses and the right mastoid air cells are clear. New fluid is present within a few dependent left mastoid air cells. Redemonstrated is a postinflammatory nasopharyngeal cyst (aka Tornwaldt cyst), unchanged in appearance.
There are multiple new foci of restricted diffusion with matching ADC hypointensity throughout both bilateral supratentorial and infratentorial vascular territories. Given the history of endocarditis, this is most consistent with multiple small embolic infarctions. 