Re-evaluate for progression of prior abnormalities, and assess for new insult of the right centroparietal on the basis of EEG change in this area: CJD remains at top of differential. There are more conspicuous areas of high DWI signal in the right caudate, posterior right cingulate gyrus, right medial parietal lobe cortex, and left thalamus and posterior cingulate gyrus. There is no associated abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged mild scattered periventricular and subcortical white matter T2 hyperintense lesions, which are nonspecific. There is cavum septum pellucidum and vergae. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening and secretions in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.
Mild nonspecific cerebral white matter lesions may represent chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. More conspicuous areas of asymmetric signal abnormality in the right caudate, posterior right cingulate gyrus, right medial parietal lobe cortex, and left thalamus and posterior cingulate gyrus may once again represent a form of Creutzfeld Jacob disease.