61 years Female (DOB:10/15/1954)Reason: r/o subacute CVA. Previous CVA 1999, new onset symptoms 2 weeks ago. CTH negative History: Slurred speech, unilateral R hand weaknessPROVIDER/ATTENDING NAME: MINDY L JACOBS TIPU S PURI There is redemonstration of confluent periventricular white matter T2 and FLAIR signal hyperintensity which was also present on the prior exam but has progressed.There is redemonstration of a focus of encephalomalacia centered along the right middle frontal gyrus which is associated with ex vacuo effect along the right lateral ventricle and a predominantly subcortical white matter signal hyperintensity on T2 and FLAIR MRI. This has not changed since the previous examThere are multiple punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia thalami and brainstem. These were also present on the prior exam and have not changed substantially.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 demonstrate mild mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam periventricular white matter lesions have progressed. At this age these are most likely vascular related.2.Encephalomalacia in the right middle frontal gyrus is most likely related to prior infarction.3.There are multiple lesions in the basal ganglia, thalami, internal capsules and brainstem which likely represent prior lacunar infarcts4.There is no evidence for acute or subacute cerebral infarction.