Male 60 years old Reason: new CVA History: occipital head numbness. No evidence of diffusion restriction to suggest acute infarct. The areas of minimally increased signal in the bilateral posterior internal capsules do not demonstrate low ADC signal and are not acute infarcts. There are multiple bilateral areas of T2/FLAIR hyperintensity in the brainstem, cerebellar hemispheres, basal ganglia and thalami bilaterally. There is also T2/FLAIR hyperintensity in the periventricular and subcortical white matter. These findings are most compatible with multiple prior lacunar infarcts and chronic small vessel ischemic disease. A new focus of T2/FLAIR hyperintensity in the right temporal lobe likely represents a focus of encephalomalacia of a prior infarct with gliosis. New punctate foci of susceptibility in the right thalamus and left middle cerebellar peduncle may correspond to prior punctate hemorrhage or calcification.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Mild mucosal thickening in the left maxillary sinus is again seen.
1.Extensive abnormal T2/FLAIR hyperintense foci throughout the brain parenchyma compatible with chronic small vessel disease and multiple prior lacunar infarcts, increased from the prior exam in 2015. No evidence of a superimposed acute infarct.2.No evidence of acute intracranial hemorrhage or mass.