Reason: evaluate for RUE and R facial weakness and hemorrhagic transformation of medial L thalamus and splenium of corpus callosum History: pls see above1/4/193878 yearsMale MRI of the brainThere is redemonstration of multiple small subcentimeter foci of diffusion restriction located along the right occipital pole, the right thalamus and to a lesser degree the left occipital pole in the cerebellar hemispheres bilaterally. These are less conspicuous on the current exam when compared to the prior exam from 1/20/2016. No new foci of diffusion restriction are appreciated.There is redemonstration of a hemorrhagic focus located in the left thalamus associated with surrounding T2 and FLAIR signal hyperintensity which signal hyperintensity extends into the left midbrain, left thalamus and left internal capsule. This hemorrhagic focus was smaller on the 1/20/2016 exam but is similar in size relative to the CT scan from 1/23/2016.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple foci of punctate signal hypointensity within the subcortical white matter.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. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left vertebral artery slightly larger than the right vertebral artery.MRA neck:The MR angiography of the neck is suboptimal and that provides little information.
1.There is redemonstration of multiple small foci of infarction in the occipital lobes, thalami and cerebellar hemispheres which continue to evolve and are less conspicuous on the current exam.2.There is redemonstration of a small hemorrhage in the left thalamus associated with surrounding brainstem and internal capsule edema which is stable compared to the prior CT exam from 1/23/2016 but appears larger than the MRI exam from 1/20/2016.3.There is no evidence for intracranial cerebrovascular occlusive disease.4.The MR angiogram of the neck is suboptimal. Little information can be gleaned from it with regards to carotid and vertebral arteries. Perhaps a CT angiogram of the neck could be more successful in evaluating the cervical portions of the vertebral and carotid arteries.5.There are multiple subcortical white matter foci of microhemorrhage present. This pattern is in combination with the foci of hemorrhage in the thalamus is nonspecific. It is possible the patient also has amyloid angiopathy in addition to hypertensive type hemorrhage.