 There is a small area of restricted diffusion in the left hippocampal tail and perhaps in the bilateral centrum semi ovale. There are extensive areas of high T2 signal in the bilateral cerebral and pontine white matter and more focal hypoattenuating lesions in the basal ganglia, corona radiata, and left thalamus. There is a punctate focus of susceptibility effect in the left anterior insula. There are multiple chronic supratentorial and infratentorial foci of susceptibility effect. The ventricles and sulci are unchanged. There is no midline shift or mass effect.
1. Punctate focus of left anterior insula recent hemorrhage superimposed upon multiple chronic supratentorial and infratentorial microhemorrhages.2. Recent infarction of the left hippocampal tail and perhaps in the bilateral centrum semi ovale superimposed on a background of extensive small vessel ischemic white matter disease and multiple chronic lacunar infarcts. 