 No diffusion-weighted abnormalities are identified to suggest acute ischemia. Encephalomalacia within the right temporal, occipital, and parietal lobes is compatible with a chronic infarct, present on prior CTs, but new from the prior MRI. An additional focus of encephalomalacia within the left occipital lobe is present on the most recent CT, but new from the prior MRI. Mild susceptibility artifact within these regions is compatible with chronic blood products. There is also minimal enhancement associated with the left occipital infarct. Moderate periventricular and subcortical T2 signal abnormality is compatible with chronic small vessel ischemic disease. Prominence of the ventricular system and cortical sulci is consistent with global parenchymal volume loss, similar to recent CTs. There is a partially empty sella. There are no extra-axial fluid collections. The paranasal sinuses and mastoid air cells are clear. There are bilateral lens implants.
1. Multifocal areas of encephalomalacia including the right temporal-occipital lobe as well as additional areas in the right parietal lobe and left occipital lobe consistent with chronic infarcts. No evidence of acute infarct or intracranial mass effect.2. Moderate chronic small vessel ischemic disease.3. Unchanged prominence of the ventricular system which is at least predominately related to parenchymal volume loss.