Male, 59 years old, with left hemiparesis. Restricted diffusion is evident within the right MCA distribution including a large confluent area involving the right middle frontal gyrus, operculum, and insula. Scattered smaller foci restricted diffusion are also seen more posteriorly and inferiorly within the right parietal and temporal lobes.The areas of restricted diffusion demonstrate corresponding T2 hyperintensity with mild associated edema. There may be slight effacement of the right lateral ventricle, but no significant generalized mass effect is seen. No evidence of hemorrhagic conversion is detected. A few scattered foci of non-diffusion-restricting T2 hyperintensity are seen within the cerebral white matter, likely indicating chronic microvascular ischemic disease.The right ICA flow void is absent through the carotid canal with reconstitution intracranially. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are otherwise normal in size and morphology.Mucosal inflammation is evident in the paranasal sinuses and there are fluid levels within the maxillary sinuses. Patchy fluid opacification is seen in the mastoid air cells.
Acute infarction in the right MCA distribution involving primarily the right middle frontal gyrus, operculum and insula. No evidence of hemorrhagic conversion is seen. No significant generalized mass effect is noted.