Altered mental status. Evaluate for acute stroke. There is a punctate focus of diffusion restriction in the right thalamus. There is no evidence of intracranial hemorrhage or mass effect. There is mild parenchymal volume loss. There are scattered areas of abnormal T2 hyperintensity within the periventricular white matter, consistent with chronic small vessel ischemic changes. There is no midline shift or herniation. There is opacification of the right maxillary sinus and to a lesser degree left maxillary sinus with low T2 signal and remodeling of the right medial maxillary sinus wall. There is deformity of the right lamina papyracea, likely from prior blowout fracture. The skull and extracranial soft tissues are otherwise unremarkable. Incidentally noted is a partially empty sella. There are bilateral lens implants.
1. Acute right thalamic microinfarct.2. No evidence of intracranial hemorrhage or mass effect.3. Opacification of the bilateral maxillary sinuses. Based on comparison to an MRI from 6/6/2003, this most likely represents inspissated secretions and is chronic. Please correlate with patient's clinical history and symptoms.