Altered mental status, evaluate for infarct. There is no evidence of diffusion restriction. There are scattered and confluent areas of increased signal on T2/FLAIR images in the periventricular and subcortical white matter consistent with mild to moderate chronic small vessel ischemic changes. There is a more focal area of increased signal on T2/FLAIR images with volume loss in the left frontal lobe posteriorly involving the middle and superior gyri. There is also moderate degree of global parenchymal volume loss. There is dilatation of the ventricular system which is likely on an ex vacuo basis. The flow voids of the internal carotid arteries are not seen with occlusion and high-grade stenosis involving the right and left internal carotid arteries, respectively, demonstrated on the recent CTA. There is no evidence of an intracranial mass. Calvarium and extra cranial soft tissues are grossly unremarkable.
1. No evidence of acute infarct.2. Chronic infarct in the left posterior frontal lobe.3. Mild to moderate chronic small vessel ischemic disease.4. Absence of bilateral internal carotid artery flow voids compatible with occlusion/stenosis demonstrated on recent CTA.5. Moderate degree of global parenchymal volume loss.