History of stroke, left leg pain, and altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered confluent and punctate cerebral white matter T2 hyperintensities, without restricted diffusion. In addition, there is encephalomalacia in the left parietal lobe and periventricular frontal lobe. There are few scattered foci of susceptibility effect in the periphery of the bilateral cerebral hemispheres. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is an apparent outpouching from the terminal right internal carotid artery that measures approximately up to 8 mm. There may also be a right middle cerebral artery outpouching. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter T1 and T2 hyperintense lesion in the right parietal bone, which may represent a hemangioma or lipoma.
1. No evidence of acute intracranial hemorrhage or acute infarction. 2. Chronic left parietal and frontal lobe watershed distribution infarcts and small vessel white matter disease.3. Scattered foci of susceptibility effect in a lobar distribution may represent amyloid angiopathy, for example.4. An apparent outpouching from the terminal right internal carotid artery that measures approximately 5 mm may represent an aneurysm. A possible right middle cerebral artery outpouching may represent partial volume artifact versus an aneurysm as well. Dedicated vascular imaging is recommended for further evaluation.