 There are multiple foci of restricted diffusion throughout the right cerebral hemisphere predominantly in the deep white matter but also including the right basal ganglia as well as the right precentral gyrus. Foci of restricted diffusion along the corpus callosum are also noted. Mild diffusion restriction is also seen in the left posterior frontal and left parietal lobes. There has been evolution of the previously seen infarcts from MRI from 1/27/2016 involving the left frontal lobe.There is FLAIR hyperintensity associated with the above-mentioned infarcts. There are scattered foci of susceptibility effect compatible with chronic blood products which are similar to prior, particularly along the right lateral ventricle margin with additional areas including the left subinsular region, right lateral thalamus, and few foci involving the right pons and cerebellum. There is also a background of moderate degree of periventricular and subcortical FLAIR hyperintensity which is nonspecific but compatible with chronic small vessel ischemic disease. There is no intracranial mass or mass effect. No hydrocephalus. There is diffuse opacification involving the sphenoid sinus with frothy secretions and fluid levels as well as bilateral mastoid air cell opacification, which may be related to intubation. Mild paranasal sinus opacification elsewhere.MRA HEAD
1. Multiple acute infarcts in the bilateral, but predominantly right, cerebral hemispheres as described above. There has also been evolution of previously seen left posterior frontal infarct. Background of moderate chronic small vessel ischemic disease also noted.2. There is high-grade stenosis or near occlusion involving the right internal carotid artery, new since prior CT angiogram 1/26/2016. Extent of residual flow can be better assessed with CTA if clinically indicated. There is also significant attenuation/decreased flow involving the right middle cerebral artery and its branches compared to the left.3. Scattered foci of chronic hemorrhage appear similar to prior, relatively more prominent in the right periventricular white matter.