History of CVA, dementia, schizophrenia, presenting with subacute AMS consistent with catatonia, requiring ECT. There is ring-like restricted diffusion that measures up to 10 mm in the subcortical white matter anterior to the right precentral sulcus. There is also a punctate focus of restricted diffusion in the subcortical white matter of the left precentral gyrus. There is a background of extensive cerebral white matter confluent T2 hyperintensity. There is no evidence of intracranial tumors. There is no abnormal intracranial enhancement. There appear to be scattered foci of susceptibility effect in the cerebral hemispheres, although precise delineation is limited by patient motion. There is diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions within the posterior paranasal sinuses. There is mild hyperostosis of the skull, particularly in the left temporal region. The orbits are grossly unremarkable.
1. Ring-like restricted diffusion that measures up to 10 mm in the subcortical white matter anterior to the right precentral sulcus and a punctate focus of restricted diffusion in the subcortical white matter of the left precentral gyrus likely represent recent infarcts superimposed upon a background of extensive chronic small vessel ischemic disease. Dedicated head and neck vascular imaging may be useful for further evaluation, if clinically warranted.2. Diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes is suggestive of Alzheimer's disease. 3. Apparent scattered foci of susceptibility effect in the cerebral hemispheres may represent chronic microhemorrhages, perhaps related to amyloid angiopathy, for example, although precise delineation is limited by patient motion. Discussed with Dr. Davey at 9:15 AM on 3/26/15.