Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for strokes History: right sided weakness and expressive aphasia Brain MRIThere are scattered restricted diffusion areas involving left basal ganglia and frontal and parietal lobe especially left inferior lobule indicating acute ischemic infarct. There is no evidence of susceptibility lesions within the restricted diffusion area indicating no MR evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate more than 90% segmental stenosis of the left MCA proximal M1 segment. In addition, there is a suspicious about 50-70% of luminal stenosis on the left internal carotid artery cavernous sinus segment.There are multifocal luminal narrowings involving proximal right MCA M1 segment and proximal right MCA M2 segment.Constellation of above findings indicate intracranial arthrosclerotic disease with significant (more than 70%) arterial luminal stenosis at right MCA proximal M1 segment. Though the possibility of partially recanalized embolus cannot be completely excluded.Vertebrobasilar system appears to be normal.
1. Acute ischemic infarct without evidence of hemorrhagic conversion involving left basal ganglia, left frontal lobe and left parietal lobe which is left MCA territory.2. Intracranial arthrosclerosis are seen with the multifocal areas degree arterial luminal stenosis. In particular, left MCA proximal M1 segment shows more than 90% luminal segmental stenosis. Differential diagnosis of this stenosis include partially recanalized embolus. 