Altered mental status.. There is a chronic left thalamic lacunar infarct with susceptibility indicating chronic microhemorrhage in this region. Just posterior lateral to this is a punctate focus of restricted diffusion suspicious for acute ischemia with artifact a less likely possibility.Examination is severely motion degraded however there is no intracranial mass or mass effect. There is a periventricular and subcortical T2/FLAIR hyperintensity scattered in the periventricular and subcortical white matter which is nonspecific but compatible with chronic small vessel ischemic disease and similar to prior. Susceptibility-weighted sequence is motion degraded and multiple scattered small foci of chronic microhemorrhage are better seen previously. Foci of T2 hyperintensity in the bilateral subinsular region, right greater than left, are similar to prior and may represent prominent perivascular spaces or chronic lacunar infarcts. No midline shift or herniation. No extra-axial collections. No hydrocephalus. There is moderate degree of global parenchymal volume loss. Calvarium and extracranial soft tissues are grossly unremarkable within the limits of motion degradation.
1. Examination is moderately motion degraded. There is suggestion of punctate focus of acute infarct adjacent to a chronic hemorrhagic left thalamic infarct.2. Moderate chronic small vessel ischemic disease. No evidence of intracranial mass or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.