Possible hemorrhagic stroke. History of kidney disease as an adult. 50 sutural female Since the exam of 2008 the patient has developed hypodense foci in the medial anterior aspect of the left thalamus and the superior aspect of the right thalamus anteriorly and in the right caudate nucleus. These are identified on an MRI of 8/19/09 . There is redemonstration from that time of focus of encephalomalacia in the inferior aspect of the left cerebellar hemisphere also identified and exams dating back to 2006 and the identified during the acute stage on 11/12/05.A focus of encephalomalacia is also present along the left temporal lobe identified on an MRI of 8/19/09. A focus of encephalomalacia is present along the right thigh medial parietal lobe and on either side of the intra-parietal sulcus involving superior parietal lobule, small portion of the precuneus and a small portion of the right inferior parietal lobule. There is also involvement of a small focus along the left cuneus.There is atrophy of the brain a somewhat early for this age.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Multiple foci of encephalomalacia as indicated above most of which are in the posterior circulation however there are a few in the anterior circulation bilaterally. These have developed over time and appeared many of these were not present on 2/25.08 right MRI from 8/19/09 identified. The distribution of the anterior circulation lesions suggests watershed distribution.