Altered mental status. Seizures. Evaluate for acute CVA. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. Again seen are extensive areas of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter as well as the pons most likely representing advanced chronic small vessel ischemic disease. There is asymmetric, greater involvement extending into the left superior frontal gyrus. Small lacunar infarcts also noted involving the corona radiata and bilateral basal ganglia. Small areas of volume loss also noted within the bilateral cerebellar hemispheres which may also be related to prior ischemia. Small scattered foci of susceptibility consistent with chronic microhemorrhages are noted including in the left pons, right putamen, and the left superior frontal gyrus. Global parenchymal volume loss is noted, which appears advanced for age. Volume loss involving the hippocampi, particularly on the right, also noted. No hydrocephalus. There is mucosal thickening involving the right maxillary sinus as small amount of scattered fluid in the right ethmoid and sphenoid sinus. Secretions fill the nasopharynx, and there is opacification of the bilateral mastoid air cells, findings which may be related to intubation.
1. No evidence of acute infarct. No intracranial mass effect.2. Advanced chronic small vessel ischemic disease.3. Advanced parenchymal volume loss for age.4. Small scattered foci of chronic microhemorrhage with foci in the pons and right putamen suggestive of of chronic hypertension as the etiology.