 There are two punctate foci of restricted diffusion in the right superior frontal gyrus and left inferior frontal gyrus. There is diffuse global volume loss that is more focally pronounced in the bilateral hippocampi, greater on the right. There are scattered predominantly subcortical white matter T2 signal abnormalities, with lesser degree of periventricular white matter involvement, along with symmetric involvement of the bilateral external capsules and subinsular white matter. There is no associated susceptibility abnormality. There is unchanged volume loss in the anterior temporal lobes bilaterally with ex vacuo dilatation of the temporal horns. There is a partial empty sella. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.
1.Two punctate foci of restricted diffusion in the left inferior frontal gyrus and the right superior frontal gyrus likely representing acute nonhemorrhagic infarcts, although small metastatic lesions are in the differential diagnosis, given the history of colon cancer. Further evaluation with contrast enhanced MRI can be considered, if clinically indicated.2.Predominately peripheral subcortical white matter T2 signal abnormalities suspected to represent chronic distal small vessel infarcts, possibly secondary to vasculitis/vasculopathy, and CADASIL variant. 3.Global volume loss that is most pronounced in the hippocampi, greater on the right. The overall pattern supports the clinical suspicion of Alzheimer's disease.Findings were discussed with Dr. Mastrianni over the telephone at 2:59 p.m. today.