 BRAIN: There is a punctate focus of restricted diffusion with FLAIR hyperintensity in the left thalamus, and a small second focus in the right subinsular/external capsule region. Compared to the prior MRI, there is volume loss in the left caudate/basal ganglia with resulting ex vacuo dilatation of the left frontal horn. There is resolved enhancement in the left caudate and lentiform nucleus. However, intrinsic T1 high signal in these structures persists. These findings were present to represent nonketotic hyperglycemia related changes. There is a nonenhancing small T2 hyperintensity within the left cerebellar white matter which is new and nonspecific. There is also a new nonspecific focus of FLAIR hyperintensity in the right corona radiata. There is new hyperintense T2 signal abnormality in the left cerebral peduncle at the level of the midbrain and pons, and redemonstration of abnormal signal in the right cerebral peduncle; findings suggest Wallerian degeneration, new on the left and persistent on the right. There is no significant mass effect or midline shift. The ventricles and sulci are more prominent consistent with increased volume loss. There is an incidental cavum septum pellucidum et vergae. ORBITS: Evaluation of the orbits is limited due to motion artifact. The optic nerves and optic sheaths are symmetric and show normal signal intensity. The globes are within normal limits. The extraocular muscles show normal caliber and signal intensity. There is no suspicious enhancement in the orbit. The cavernous sinuses enhance symmetrically. The pituitary gland is not enlarged. The pituitary stalk is midline. The optic chiasm is within normal limits.
1.Two punctate small acute infarcts in the left thalamus and the right subinsular/external capsule region without significant mass effect.2.No orbital mass or abnormal enhancement, although examination is limited by motion artifact.3.Evolution of previously seen findings present to be related to nonketotic hyperglycemia. Interval focal volume loss in the left caudate and basal ganglia with no residual enhancement, although persistent intrinsic T1 hyperintensity noted in the left lentiform nucleus.4.New nonenhancing small left cerebellar white matter and right corona radiata T2 hyperintensity which are nonspecific.5.Progressive T2 signal abnormality in the left cerebral peduncle which may represent Wallerian degeneration. Persistent right cerebral peduncle T2 hyperintensity without significant change, representing previously seen Wallerian degeneration.Findings were communicated to Dr. Christopher Boyle at 10:20 AM today over the telephone.