Altered mental status. History of CAD and diabetes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are punctate and confluent T2 hyperintensities in the subcortical and periventricular white matter, in the left caudate, in the bilateral thalami, in the brainstem, and in both cerebellar hemispheres, consistent with extensive chronic small vessel ischemic findings and chronic lacunar infarcts. Global volume loss is also greater than expected for the patient's age.There are mild diffusion hyperintensity with ADC isointensity along the right periatrial white matter, and along the medial left peri-atrial white matter adjacent to an area of chronic lacune (3/17-19), likely representing evolving subacute lacunar infarctions. There is mild associated FLAIR hyperintensity in these locations. There is no midline shift or herniation. The major cerebral flow voids are intact.
1. There are findings suggestive of a few subacute lacunar infarctions in the peri-atrial white matter bilaterally.2. There are extensive underlying chronic small vessel ischemic changes with chronic lacunar infarcts, affecting both supratentorial and infratentorial structures.