The lateral and third ventricles have increased significantly in size and cortical sulci diffusely are slightly wider, but there is no focal area of lobar atrophy. In particular, the mesial temporal structures are not atrophied out of proportion to the remainder of the brain, however there is an enlargement of the temporal horn of the lateral ventricles.
The other major change is the development of new deep white matter focal ischaemic lesions, notably in the anterior limb of the right internal capsule and subependymomas in relation to both frontal horns. No restricted diffusion detected to suggest any recent lesion. The perfusion study shows patchy decreased perfusion, with most marked loss in left parietal lobe (not shown).
Conclusion: Evidence of further deep white matter ischaemic change and patchy cerebral perfusion. No anatomical features diagnostic of Alzheimer's disease, nor of focal lobar atrophy.