 There is no acute infarct, mass effect or midline shift. Previously seen punctate infarct in the right postcentral sulcus region has resolved. On the diffusion images, there are small foci of susceptibility effect in the bilateral thalami with punctate high diffusion signal artifact adjacent to the focus of susceptibility in the right thalamus (series 301 image 211 and 212). There is moderate confluent and patchy T2 hyperintensity, also affecting the central pons, nonspecific but likely representing chronic microvascular ischemic changes which are similar to prior exam. There are multiple unchanged small to punctate foci of susceptibility effect in the cerebellum, brainstem, and bilateral thalami as well as the basal ganglia on the left likely represent chronic microhemorrhages. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable.
Moderate chronic microvascular ischemic changes with no acute infarct, mass effect or midline shift.