Right hand weakness which started 2 weeks ago with prior history of stroke. There is interval appearance of a punctate T2 hyperintense lesion in the left precentral gyrus involving the putative hand center without discernible restricted diffusion. There is unchanged encephalomalacia in the right middle cerebral artery territory involving the frontal, parietal, and temporal lobes. There is also encephalomalacia within the bilateral cerebellar hemispheres, left larger than right. There is scattered patchy high T2 signal in the cerebral and pontine white matter. There are probable enlarged perivascular space in the bilateral basal ganglia. There is no evidence of an acute infarct. There is ex vacuo dilatation of the lateral ventricles superimposed on a background of diffuse cerebral volume loss. There is unchanged susceptibility effect in the left superior frontal gyrus, which is compatible with chronic hemorrhage. There is no evidence of mass, midline shift or mass effect. The imaged paranasal sinuses and mastoid air cells are unremarkable. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Interval appearance of a punctate lesion in the left precentral gyrus involving the putative hand center may represent a subacute infarct. Otherwise, extensive areas of chronic infarcts in multiple vascular territories are unchanged.