78 years, Male, vertigo and hearing loss. History of HCC and atrial fibrillation. Multiple sequences are mildly motion degraded. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration for age. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and similar to prior. There is a focus of susceptibility indicating chronic hemorrhage in the right occipital lobe, which is new since prior. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits without evidence of bilateral intraocular lens implants. There is partial opacification of the right-sided mastoid air cells. There is also mild opacification of the bilateral anterior ethmoid air cells. Bone marrow signal and extracranial soft tissues are grossly unremarkable.
1. Mild chronic small vessel ischemic changes similar to prior study from 12/18/2014. There is no evidence of acute ischemia.2. Small focus of chronic hemorrhage in the right occipital lobe which is new since prior MRI. This finding is nonspecific in etiology.3. Partial opacification of the right mastoid air cells.4. If there is significant suspicion for intracranial metastatic disease consider postcontrast sequences, although there is no gross evidence of intracranial metastatic disease.