81 years, Female, left-sided weakness. There is restricted diffusion involving the right posterior frontal periventricular white matter extending into the posterior putamen and subinsular region consistent with acute infarct. There is corresponding T2/FLAIR hyperintensity. There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. Chronic cortical infarcts also noted in the left posterior parietal and left lateral occipital lobes. Chronic infarct in the right lateral cerebellar hemisphere also noted. Global parenchymal volume loss is evident including of the bilateral hippocampi. There is gliosis and volume loss involving the right anterior temporal lobe which may also be related to prior injury. No hydrocephalus or extra-axial collections. Multiple sequences are motion degraded, especially the susceptibility sensitive sequences which limits evaluation for hemorrhage. However no large hemorrhage is evident. No intracranial mass or mass effect. No midline shift or herniation. There is diffuse opacification of the left maxillary sinus as well as patchy opacification elsewhere in the paranasal sinuses.
1. Acute infarct involving the right posterior frontal periventricular white matter extending into the subinsular region. Multiple supra- and infratentorial chronic infarcts as described above.2. Moderate chronic small vessel ischemic disease.