63 years Male (DOB:11/3/1952)Reason: Transplant pt with possible pulm nocardia; r/o CNS nocardiosis History: As abovePROVIDER/ATTENDING NAME: NIR Y URIEL NIR Y URIEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There are patchy foci of T2 and FLAIR signal hyperintensity present. One involves gray and white matter in the right inferior frontal gyrus measuring approximately 21 mm one in the right middle frontal gyrus measures approximately 21 mm. One in the left precentral gyrus measures 8 mm. One in the right temporal lobe is associated with encephalomalacia and measures approximately 60 x 26 mm axial dimensions. One in the left inferior parietal lobule measures 12 mm additional small T2 and FLAIR hyperintense lesions are also present in the occipital lobes. These were also present on the prior exam from 11/14/2015.Couple punctate foci of signal hyperintensity are present in the right cerebellar hemisphere.On susceptibility imaging there are multiple punctate foci of signal hypointensity in the cerebellar hemispheres and in the basal ganglia as well as in the periventricular white matter and subcortical white matter of the supratentorial brain. There is gyriform signal hypointensity in the right middle frontal gyrus and right temporal lobe where there are foci of encephalomalaciaNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam there is no significant interval change. 2.There is redemonstration of multiple lesions scattered throughout supratentorial brain which are compatible with small foci of chronic stage infarction.3.There is redemonstration of multiple microhemorrhages scattered throughout the brain. A distinct pattern is not appreciated.