OHT presenting with altered mental status. There is a punctate enhancing lesion in the left cerebellar hemisphere. There also appear to be punctate foci of restricted diffusion in the right occipital lobe white matter. There are small areas of encephalomalacia in the bilateral basal ganglia and thalami, right middle frontal gyrus, left superior frontal gyrus, and right middle cerebellar peduncle. There is also a background of diffuse cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There are several punctate foci of supratentorial and infratentorial susceptibility effect. There are a few small foci of high T1 signal and susceptibility effect in the bilateral basal ganglia, which may represent mineralization or prior hemorrhage. There is no abnormal intracranial enhancement. 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 is mild mucosal thickening in the right maxillary sinus.
1. A punctate enhancing lesion in the left cerebellar hemisphere may be ischemic, neoplastic, or infectious in nature.2. Punctate foci of restricted diffusion in the right occipital lobe white matter may represent acute infarcts.3. Multiple small chronic infarcts and a background of probable mild cerebral white matter small vessel chronic ischemia.4. Several punctate foci of supratentorial and infratentorial susceptibility effect are nonspecific, but may represent septic emboli or prior microhemorrhages, for example. 