Syncope and collapse. History of metastatic gastric adenocarcinoma. Possible seizure. Evaluate for metastasis. There is diffuse prominence of the cortical sulci in proportion to the cerebral ventricles consistent with moderate global volume loss. There is encephalomalacia involving the right MCA territory with gliosis. Patchy T2/FLAIR hyperintensity in the periventricular white matter is demonstrated. No intracranial hemorrhage is identified. No midline shift or mass effect is appreciated. There is no diffusion restriction to suggest ischemia. No abnormal enhancing lesions are identified. Opacification of the left sphenoid sinus is again seen.
1. There is diffuse global volume loss, right MCA territory encephalomalacia from chronic infarction, and white matter changes likely related to chronic microvascular ischemic change.2. There is no evidence for acute ischemia.3. There is no evidence for intracranial metastasis.4. Left sphenoid sinus opacification.