 There is extensive subcortical and periventricular white matter abnormal T2 signal along with additional foci within the pons and bilateral basal ganglia. This is consistent with chronic small vessel ischemic disease and old lacunar infarcts. Of note, there are no significant cerebellar lacunar infarcts. There are no diffusion-weighted abnormalities to suggest acute ischemia. There is no abnormal enhancement within the brain. There is trace focal ectasia of the left anterior cerebral artery just prior to its first bifurcation, which was present on prior CT. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. There is no mass effect or midline shift. There are no extra-axial fluid collections. There is a small mucous retention cyst in the left maxillary sinus.The left mid to distal submandibular duct is significantly dilated, measuring up to 12 mm in greatest diameter, and beaded in appearance proximally within the glandular tissue. Within the dilated portion, there is no definite filling defect or enhancing lesion. No obstructing hyperdense stone is noted on prior CTA. The left submandibular gland is slightly atrophic compared to the right with areas of minimal fatty replacement.
1. No evidence of acute ischemia or mass within the brain.2. Extensive white matter T2 signal abnormality involving the brainstem, basal ganglia, and periventricular and subcortical white matter which represents chronic lacunar infarcts and extensive chronic small vessel ischemic disease. 3. Dilated left submandibular duct gland without definite obstructing lesion within the dilated portions and slightly atrophic gland; correlate with history of chronic sialadenitis. Otherwise, MRI of the face with contrast may be considered for further evaluation.