Worsening cognition. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a chronic lacunar infarct in the left basal ganglia and corona radiata, with a small amount of marginal hemosiderin staining. There is moderate diffuse cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There are a few scattered foci of susceptibility effect in the bilateral cerebral hemispheres. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are low T2 signal secretions in the left sphenoid sinus, which may be related to chronic proteinaceous material or fungal elements.
Chronic lacunar infarct in the left basal ganglia and corona radiata and moderate cerebral white matter small vessel ischemic disease, as well as scattered foci of susceptibility effect, which may represent amyloid angiopathy, but no evidence of intracranial hemorrhage, mass, or acute infarct. 