 There is a punctate focus of diffusion hyperintensity in the right inferior parietal periventricular white matter with T2 hyperintensity which is new since remote MRI from 5/14/2007. There is isointense corresponding ADC signal.Again seen is evidence of extensive chronic small vessel ischemic disease with patchy T2/FLAIR hyperintensities in the periventricular and subcortical white matter as well as in the pons, minimally progressed in the interval. Again seen are areas of encephalomalacia involving the left temporo-occipital lobe. Lacunar infarct involving the left frontal corona radiata is unchanged. Confluent FLAIR hyperintensity in the right frontal corona radiata and centrum semiovale is also similar to prior. There is small infarct involving the right cerebellar hemisphere which appears chronic but is new since prior study from 2007.There is linear area of encephalomalacia with susceptibility involving the right basal ganglia and internal capsule consistent with prior hemorrhagic infarct. In addition, punctate susceptibility signal is again seen in the left basal ganglia as well as associated with the left temporo-occipital infarct compatible with chronic blood products. There is evidence of Wallerian degeneration with volume loss along the right corticospinal tract. There is volume loss with enlarged ventricles and sulci, slightly progressed since the previous study. There is no midline shift. Basal cisterns are patent. No evidence of herniation.There is opacification of the right sphenoid sinus. Evidence of intraocular lens replacement.
1. Punctate focus of diffusion hyperintensity in the right inferior parietal periventricular white matter which is suspected to represent a tiny subacute infarct.2. Evidence of advanced chronic small vessel ischemic disease which has minimally progressed since prior study from 2007. Again seen are multiple chronic infarcts including at the left temporal-occipital lobe junction and right basal ganglia/internal capsule. Small right cerebellar lacunar infarct appears chronic but new since prior study from 2007. Please see additional details above.