Female, 55 years old, with left-sided weakness, evaluate for extent of stroke, acute versus subacute versus chronic. A moderately sized area of infarction in the right inferior cerebellum demonstrates no evidence of restricted diffusion, but neither is there frank encephalomalacia and the parenchyma appears to be mildly edematous. Also noted is hemosiderin staining within the infarct suggesting petechial blood product.Scattered foci of mildly restricted diffusion are seen within the left frontal white matter, the right splenium of the corpus callosum, and scattered through the right posterior temporal and occipital lobes. These areas show mild corresponding FLAIR signal abnormality but no significant edema or generalized mass effect.On diffusion-weighted images, there is a generalized hyperintensity involving the left anterior temporal lobe structures. This does not correlate to any clear signal abnormality on the other sequences.A right parietal approach ventricular catheter is seen with its tip crossing the midline and terminating within or along the left frontal horn. There is a thin, 3 mm subdural collection and/or dural thickening along the anterior right cerebral hemisphere. This produces no significant generalized mass effect.Scattered patchy foci of T2 hyperintensity are seen elsewhere in the cerebral hemispheres, the brainstem and the left cerebellum. Small chronic infarcts are noted within the left cerebral hemisphere. The ventricles are normal in size and morphology.On dedicated MRA imaging, no significant stenosis or occlusion is seen within the major intracranial vascular structures. Both PICAs are at least partially visualized but this is approaching the technical limits of the exam. No aneurysms are detected.
1.A moderately sized infarct of the right inferior cerebellum shows imaging characteristics suggesting a subacute time course. There is likely petechial hemorrhage associated with this infarct, but no frank hematoma.2.Scattered small areas of restricted diffusion are seen in both hemispheres as described above compatible with acute ischemic lesions.3.Generalized diffusion hyperintensity within the anterior left temporal lobe is seen but there is no corresponding abnormality on the other fMRI sequences. This finding may therefore be artifactual. Such findings can however be seen in the context of recent seizure activity.4.A ventricular shunt device is in place. Also noted is a thin right cerebral subdural collection and/or dural thickening. Correlation with prior history is suggested.5.Unremarkable MRI evaluation of the brain.