64 years, Female, Reason: eval for progression of toxic metabolics lesions and hemorrhage There has been mild evolution of the multiple previously seen acute infarcts involving the bilateral cerebral hemispheres, left pons and left cerebellar hemisphere on recent MRI brain study dated 1/2/2016. There are however new foci of restricted diffusion consistent with new infarcts including the right frontal lobe involving the right superior frontal gyrus as well as the right paracentral lobule and in the right parietal lobe involving the periventricular white matter as well as the right splenium. There is continued evolution of the left thalamic intraparenchymal hematoma. Multiple patchy areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as in the pons which are likely reflective of chronic small vessel ischemic disease are also again noted. Chronic infarct with encephalomalacia in the right occipital lobe is also again seen as well as additional chronic infarcts including the right corona radiata, right cerebellar hemisphere, left pons, and bilateral thalami which were seen on exam dating back to 3/7/2015. Multiple scattered foci of susceptibility related to chronic microhemorrhages are again seen.No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. Minimal mucosal thickening involving the paranasal sinuses. Partial mastoid air cell opacification bilaterally is similar to prior.
1. Compared to MRI brain dated 1/2/2016 there has been evolution of multiple previously seen acute supratentorial and infratentorial infarcts and development of multiple new punctate infarcts in the right frontal and right parietal lobes.2. Continued evolution of the left thalamic intraparenchymal hemorrhage with surrounding vasogenic edema.3. Mild diffusion restriction with FLAIR hyperintensity in the bilateral middle cerebellar peduncles appears similar to prior. Finding is favored to represent Wallerian degeneration along the pontocerebellar tracts although toxic metabolic injury remains an alternative possibility.4. Background of chronic small vessel ischemic disease as well as multiple chronic infarcts as described above. Dr. Ali discussed findings of new infarcts with Dr. Buerki at 1020 hours on 1/10/2016