History of vision changes. Subdural hematoma. Evaluate for optic nerve injury, atrophy. Patient motion artifact limits the sensitivity of this examination.MRI brain:Scattered supratentorial tiny foci of restricted diffusion, which does not include the occipital lobes, with a distribution suggesting embolic etiology. Prominence of the ventricles and sulci due to age related volume loss. There is moderate to marked periventricular and subcortical white matter FLAIR signal abnormality, most prominent in the pons likely due to chronic small vessel ischemic disease. Irregularly of the flow void of the left distal vertebral artery, and chronic infarct in the left cerebellum is noted. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. Small left frontal CSF intensity hygroma. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is nonspecific fluid signal in the left mastoid air cells. Paranasal sinuses are unremarkable.MRI orbits: This portion the study was essentially nondiagnostic due to patient motion artifact. The orbits are grossly unremarkable based on the provided images.
1. Scattered tiny foci of restricted diffusion representing acute ischemia, not including the occipital lobes, with a distribution suggestive of embolic etiology.2. Within the limitations of marked patient motion artifact, no gross orbital abnormality.3. Extensive chronic small vessel ischemic disease.4. Irregular area of the left distal vertebral artery flow void with chronic left cerebellar infarct.Findings discussed with Dr. Bryan Campbell via phone at 2:20 PM on 4/25/2016. 