Diagnosis: Cerebral infarction, unspecifiedClinical question: rule out ischemic infarct, R MCA distributionSigns and Symptoms: worsening of known dysarthria, left UE, LE weakness There are no foci of diffusion restriction appreciated.There is encephalomalacia involving the right parietal lobe and to lesser degree adjacent right frontal lobe and temporal lobe as well as right insular cortex. This is all in the distribution of the right middle cerebral artery territory predominantly. There is associated loss of volume of the right cerebral peduncle. There is associated ex vacuo effect along the right lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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.
1.There is no evidence for acute infarction.2.Encephalomalacia involving right middle cerebral artery territory structures predominantly centered in the right parietal lobe but also involving the adjacent brain is most likely related to prior cerebrovascular event.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 