Reason: evaluate for new infarction, emboli, evolving lesion History: new left leg weakness, right arm weakness There is redemonstration of multiple punctate foci of diffusion restriction in both cerebral and cerebellar hemispheres predominantly in subcortical locations. There is a new punctate focus in the right cerebral hemisphere.There is a redemonstration of a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is redemonstration of multiple foci of punctate SWI signal loss in the thalami and to a lesser degree right cerebellar hemisphere, pons and basal ganglia. There is a punctate focus of diffusion restriction in the left temporal lobe.There is redemonstration of patchy and serpiginous signal loss on SWI in the right centrum semiovale associated with patchy T2/FLAIR signal hyperintensity.To a lesser degree this is also present in the left centrum semiovale.There is redemonstration of patchy signal loss on SWI in the right parietal lobe subcortical white matter associated with patchy T2/FLAIR signal hyperintensity..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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is redeomnstration of multiple punctate foci of infarction in the cerebral and cerebellar hemispheres with at least one new focus since the prior exam.2.There is redemonstration of multiple mucrohemorrhages in the thalami and to a lesser degree right cerebellar hemisphere, pons and basal ganglia. The pattern suggests hypertensive cause.3.Patchy foci of encephalomalacia are present in the right centrum semiovale, right parietal cortex and subcortical white matter and to a lesser degree left subependymal region and adjacent centrum semiovale. These likely represent encephalomalacia from prior events possibly associated with evidence of mineralization or hemosiderin deposition suggesting they are related to prior vascular events.