Alternate status. History of cerebrovascular accident, seizure disorder as well as dementia.. There is confluent and patchy T2 hyperintensity involving the cerebral white matter, most pronounced in the frontal and parietal lobes, but without associated with diffusion restriction or mass effect. This is probably related to chronic microvascular ischemia and has increased compared to the 2014 examination. Some of the foci involving the overlying cortex, especially in the left frontal lobe. These are related to chronic left MCA infarcts. There is a slitlike abnormality involving the region of the left external capsule without associated stability, probably reflect previous infarct. Otherwise, there is no diffusion restriction or susceptibility effect to indicate recent hemorrhage, accounting for basal ganglia calcifications. Progression of the white matter abnormality since 2014 is associated with progressive cerebral volume loss manifested by further expansion of the ventricles and the other CSF-containing spaces. There is no midline shift or herniation. There is no abnormal extra-axial fluid collection.Orbits are grossly normal. The mastoid air cells and paranasal sinuses are clear. There is no destructive skull lesion.
1.There is no acute infarct or acute intracranial hemorrhage. 2.Extensive white matter abnormality probably reflect chronic microvascular ischemia has increased since February 2014. 3.The more focal abnormalities in the left external capsule region and the left frontal cortex may represent previous/chronic infarcts.