Acute thalamic infarct. Evaluate for signs of neoplasm. There are new punctate foci of restricted diffusion in the right and left occipital lobes. The previously seen punctate focus of diffusion restriction along the left superior thalamus is less prominent.There are multiple punctate foci and extensive confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter which are nonspecific but consistent with advanced chronic small vessel ischemic changes. There are chronic lacunar infarcts in the basal ganglia and thalamus. There are numerous punctate foci of susceptibility artifact in the supratentorial and infratentorial compartments, consistent with hemosiderin deposition from chronic microhemorrhage. These are particularly prominent in the cerebellum and basal ganglia, favored to be related chronic hypertension. Examination is slightly motion degraded. No pathological enhancement is seen. Global parenchymal volume loss again noted. No hydrocephalus. There is no midline shift or herniation. Minimal paranasal sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable. Incidental note is made of a partially empty sella.
1. Two new punctate foci of restricted diffusion compared to 1/23/2015 compatible with acute infarcts in the bilateral occipital lobes. Recent infarct in the left superior thalamus also again seen and slightly less prominent compatible with evolution.2. Advanced chronic small vessel ischemic disease including multiple lacunar infarcts.3. Innumerable chronic microhemorrhages, particularly in the basal ganglia and cerebellum in a pattern suggestive of chronic hypertension. Additional foci in a lobar distribution may be due to chronic amyloid angiopathy.4. No findings to suggest neoplasm.