 There is a large area of diffusion restriction involving the right occipital lobe extending into the posterior right temporal lobe. Small area of diffusion restriction is also demonstrated in the left parietal lobe. Punctate areas of diffusion restriction are demonstrated in the bilateral frontal lobes, left occipital lobe, and cerebellum. These foci of restricted diffusion have matching ADC hypointensity. Small areas of gradient susceptibility with T1 hyperintensity are visualized in the right occipital/temporal lobe. Additional small areas of gradient susceptibility likely related to chronic hemosiderin deposition. The ventricles and sulci are prominent, consistent with age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter without restricted diffusion, consistent with chronic small vessel ischemic changes. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.
1. Findings are consistent with acute/subacute infarction in multiple vascular territories, most prominent in the posterior circulation involving the right occipital/temporal lobes as well as left parietal lobe. Additional numerous scattered foci of ischemia are demonstrated throughout the parenchyma. This distribution is most consistent with an embolic origin.2. Small petechial hemorrhage is visualized in the anterior aspect of the right occipital temporal lobe infarction.3. Additional small areas scattered areas of gradient susceptibility likely related to chronic hemosiderin deposition or other etiology such as amyloid angiopathy.