 Redemonstrated is T2 hyperintensity throughout the white matter, which is progressed since the 2006 MRI, now appearing confluent in several locations. As demonstrated on the more recent head CT, there are regions of encephalomalacia within the bilateral basal ganglia, corona radiata, the right cerebellum, and the left parietal lobe, from chronic ischemia. There is no restricted diffusion to suggest current acute ischemia. Signal abnormality within the left distal internal carotid flow void is again noted. There are no findings of hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear.
1.There is no restricted diffusion to suggest the presence of acute ischemia.2.Chronic ischemic changes with foci of encephalomalacia as described in detail above.