Right hemiparesis, pseudobulbar palsy. Stroke history, declining mobility, right leg weakness. There is diffuse global parenchymal volume loss supratentorially as well as infratentorially including the brainstem and cerebellum, which is advanced for age. Diffuse thinning of the corpus callosum is also noted, likely related to Wallerian degeneration. Confluent areas as well as scattered of foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Multiple areas of cavitation are noted in the bilateral basal ganglia and to a lesser degree bilateral frontal corona radiata consistent with lacunar infarcts. Lacunar infarcts are also noted in the pons bilaterally. No restricted diffusion to suggest acute ischemia. Multiple foci of susceptibility are noted within the pons, left posterior frontal periventricular white matter, and at the thalamus midbrain junction compatible with chronic microhemorrhages. No intracranial mass or mass-effect. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is moderate mucosal thickening involving the left maxillary sinus and to a lesser degree right maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Advanced chronic small vessel ischemic disease with multiple supratentorial and infratentorial lacunar infarcts. Some of these lacunar infarcts demonstrate hemosiderin staining compatible with prior hemorrhage. 2. Advanced supratentorial and infratentorial parenchymal volume loss. 3. No acute infarct or intracranial mass effect.