Acute stroke status post TPA. History of well-differentiated colonic adenocarcinoma. There are few punctate foci of restricted diffusion along the medial margin of the otherwise chronic right lateral temporal and inferior parietal infarct, where there is also diffuse susceptibility effect. There are also numerous scattered punctate foci of susceptibility effect in the cerebellum, brainstem, and bilateral thalami. There is diffuse cerebral white matter T2 hyperintensity. There is ex vacuo dilatation of the right lateral ventricle superimposed upon diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a T1 hypointense lesion in the right frontal bone that measures up to 20 mm.
1. Acute punctate infarcts along the medial margin of the otherwise chronic right middle cerebral artery territory infarct, where diffuse susceptibility effect may represent prior petechial hemorrhages and/or cortical laminar necrosis.2. Diffuse background of what likely represents chronic small vessel disease and scattered chronic hypertensive microhemorrhages.3. A T1 hypointense lesion in the right frontal bone is nonspecific, but may represent metastatic disease. Follow up via MRI with contrast may be useful.