Persistent altered mental status without clear etiology. There are multiple foci of high T2 signal and restricted diffusion scattered in the bilateral cerebral hemispheres, including the hand region of the right precentral gyrus. There is no evidence of intracranial hemorrhage or mass. There is a background of encephalomalacia in the right occipital lobe with gyriform T1 hyperintensity. There are punctate foci of encephalomalacia in the bilateral basal ganglia. There is a background of mild patchy cerebral white matter T2 hyperintensity. There is 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 secretions within the sphenoid sinuses and bilateral tympanomastoid effusions, which may be related to intubation.
1. Multiple recent small infarcts scattered in the bilateral cerebral hemispheres.2. Chronic right posterior cerebral artery infarction and bilateral basal ganglia lacunar infarcts. Discussed with Dr. Kramer at 2PM on 2/24/16.