 There is no evidence of acute infarct. There are patchy foci of T2 hyperintensity throughout the supratentorial white matter in the subcortical and deep regions as well as a more prominent focus of T2 hyperintensity and volume loss in the right anterior temporal lobe that are unchanged compared with the 3/27/2012 exam. There are linear and punctate foci of susceptibility effect within the subarachnoid space, most prominent within the right frontal lobe, that are unchanged back to 7/19/2013 (our earliest susceptibility weighted imaging). The patchy enhancement within the right temporal lesion and the linear enhancement within the left frontal lesion is unchanged dating back to 6/22/2012 (our earliest postcontrast exam). The areas of somewhat linear enhancement within the left superior parietal lobule and the posterior left frontal lobe are less prominent and faintly visualized on today's exam. There is no elevated perfusion in the regions of signal abnormality or enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants.
1.Multiple patchy regions of signal abnormality are unchanged dating back to March 2012. The enhancement within some of these lesions is either unchanged or less prominent (although this may be technical) dating back to June 2012. The differential diagnoses include again includes inflammatory or granulomatous lesions with neoplasm felt less likely due to the long-term stability.2.Unchanged superficial siderosis of unclear etiology.