Left leg pain and weakness and anosmia with history of stroke. Brain: There is cavitary encephalomalacia centered in the straight gyri bilaterally, right larger than left, as well as volume loss of the bilateral olfactory bulbs and tracks. There is also susceptibility effect along the margins of the encephalomalacic cavities, which likely represents chronic hemosiderin deposition. Furthermore, there is dural thickening and enhancement of the overlying dura in this region, which may be reactive in nature. There are subcentimeter foci of encephalomalacia in the pons and left thalamus and basal ganglia. There is unchanged extensive diffuse patchy and punctate T2 hyperintensity and scattered punctate foci of susceptibility effect in the cerebral and brainstem white matter. There is a background of mild diffuse cerebral volume loss. There is no evidence of acute infarction. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and secretions. There are also subcentimeter adenoid retention cysts.Orbits: There is a defect in the defect in the left lamina papyracea, with protrusion of orbital fat and deformity of the left medial rectus muscle. The bilateral globes and ocular adnexa otherwise appear to be intact. There is no evidence of intraorbital mass lesions or abnormal enhancement.
1. Encephalomalacia and hemosiderin deposition involving in the bilateral straight gyri, as well as the olfactory bulbs and tracks, right larger than left, which may represent the sequela of prior hemorrhagic contusions. 2. Extensive chronic small vessel ischemic disease and chronic lacunar infarcts, but no evidence of acute infarction. 3. A defect in the left lamina papyracea may represent a chronic fracture. The bilateral orbits otherwise appear unremarkable.