 Brain: Focal diffusion abnormality at right frontal subcortical white matter. Expected evolution of the previously seen infarct at right thalamus. Cerebral volume loss. Encephalomalacia in the left posterior temporal lobe again seen. Chronic right thalamic hemorrhagic infarct. Chronic right superior cerebellar infarcts. Moderate subcortical and periventricular white matter T2/FLAIR hyperintensity compatible with small vessel ischemic disease. Large susceptibility artifact in the left frontal and temporal lobe compatible with known hematoma. There is mild mass effect on the left lateral ventricle with 3-mm midline shift. There are numerous punctate susceptibility artifacts of the bilateral frontal and temporal subcortical white matter, bilateral thalami, midbrain, pons, and middle cerebral peduncle, compatible with chronic microhemorrhages. There is small amount of blood product layering in the posterior left lateral ventricle.No evidence of hydrocephalus. Moderate diffuse mucosal of thickening of paranasal sinuses. Fluid in the bilateral mastoid air cells are noted, left greater than right. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The orbits are unremarkable.Cervical spine: Alignment is anatomic without loss of vertebral body height. There are no fractures or subluxations. The marrow signal is benign. No evidence of cord contusion or epidural hematoma. No ligamentous disruption. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Mild degenerative of the cervical spine. Minimal edema seen on multiple facet joints likely due to degenerative etiology. Minimal disk osteophyte complex at levels C4/5, C5/6, and C6/7, relatively worse at C6/7, without significant central canal or neural foraminal narrowing.
1.Left frontotemporal intraparenchymal hematoma with surrounding edema and minimal rightward midline shift as seen on CT. Minimal intraventricular extension.2.Tiny focus of acute infarct in the right frontal subcortical white matter.3.Moderate chronic small vessel ischemic disease. Chronic right thalamic hemorrhagic lacunar infarct. Chronic left posterior temporal infarct. Chronic right superior cerebellar infarcts.4.Multiple chronic microhemorrhages with distribution primarily involving the the brainstem and thalami, favored to be related to chronic hypertension. 5.No evidence of ligamentous disruption or significant ligamentous injury in the cervical spine. No cord contusion or epidural hematoma. Minimal fluid involving the bilateral facet joints, which may be degenerative in etiology.