Since the most recent examination, there are now multiple supra and infratentorial punctate areas of abnormal diffusion restriction consistent with lacunar infarcts. The cerebellar hemispheres are predominantly involved right more than left with a focal lesion that appears more chronic in the left middle cerebellar peduncle. Small focal lesions are seen within the left occipital lobe, left basal ganglia, head of the caudate nucleus, tiny ones in the bilateral frontal orbital gyri, right basal ganglia and right temporal lobe (region of the amygdala, anterior temporal pole and right frontal opercular region).
An old right cerebellar infarct is again identified with unchanged gliotic appearances of the subjacent white matter.
There is again very extensive focal and confluent hyperintensity within the corona radiata with extension into the centrum semiovale consistent with microvascular ischemic changes with involvement now of the splenium of the corpus callosum but without diffusion restriction.
Impression:
Severe progressive microvascular ischemic changes as seen in patient with chronic hypertension and/or diabetes mellitus with extensive infra and supratentorial punctate areas of diffusion restriction most likely representing embolic phenomena. Rule out a central cause.