Transient left facial droop and dysarthria. There is an area of restricted diffusion involving the right parietal lobe, right occipital lobe, as well as additional foci involving the right frontal corona radiata and right anterior temporal cortex just inferior to the level of the basal ganglia. Chronic infarct in the right posterior cerebral artery territory is again seen involving the occipital lobe and medial temporal lobe. There are patchy areas as well as scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Chronic right pontine lacunar infarct. Chronic infarct in the right inferior cerebellum is also noted. There is susceptibility effect indicative of hemosiderin staining along the right PCA territory and right inferior cerebellar infarcts. Additional punctate foci of susceptibility effect compatible chronic microhemorrhages in the cerebellum are also noted.Volume loss with surrounding T2 FLAIR signal/gliosis in the anterior and medial temporal lobes is noted with ex vacuo dilatation of the temporal horns. No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. There is mild opacification of the paranasal sinuses. There are several scattered foci of signal abnormality involving the calvarium such as in the left parietal and right frontal regions with low T1 signal, with corresponding sclerotic densities seen on CT. Recent CT demonstrated additional scattered sclerotic foci such as at the left greater sphenoid wing.
1. Multiple areas of restricted diffusion consistent with acute infarcts involving the right cerebral hemisphere as described above. 2. Encephalomalacia consistent with prior infarcts in the right posterior cerebral artery territory as well as in the right inferior cerebellum are again seen. Chronic blood products are noted within these regions. There are additional foci of chronic microhemorrhage in the bilateral cerebellar hemispheres which are nonspecific but may be related to chronic hypertension. There is advanced volume loss and gliosis involving the bilateral anterior and medial temporal lobes. There is also evidence of moderate chronic small vessel ischemic disease.3. Multiple small area of signal abnormality involving the calvarial bone marrow with recent CT demonstrating multiple sclerotic foci. Findings are suspicious for sclerotic metastases.Dr. Ali discussed findings with Dr. Cejas at 1625 hrs on 5/24/2015.