Female, 79 years old, with aphasia and left handed weakness. A 10 mm focus of restricted diffusion is seen at the junction of the right inferior frontal lobe and insula. There may be a punctate focus of restricted diffusion within the right superior parietal lobule, and another within the left cerebellum.Extensive patchy periventricular T2 hyperintensity is seen, slightly progressed from the prior examination. No evidence of significant parenchymal edema or generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is observed. Ventricular size and morphology are within normal limits. No pathologic intracranial enhancement is suspected, though postcontrast images are motion degraded.
1.A diffusion restricting lesion at the junction of the right inferior frontal lobe and insula most likely represents acute ischemia. A number of additional punctate scattered diffusion restricting lesions are seen in both hemispheres and the cerebellum which may also represent small ischemic lesions.2.Extensive background periventricular T2 hyperintense lesions are seen compatible with advanced chronic small vessel ischemic disease.3.No evidence of significant generalized edema or mass effect is seen. No enhancing lesions are detected.