This patient has the full hand of degenerative vascular disease of the brain: widespread old deep (periventricular) ischemic change including lacunes (etat lacunaire), more acute deep infarction and widespread foci of hemosiderin (magnetic susceptibility) indicating sites of microhemorrhage including the brain stem. The brain is atrophic resulting in marked dilatation of the perivascular (Virchow-Robin) spaces causing the appearance of etat criblé (sieve-like state).