Clinical question: Concern for expanding left MCA stroke. Signs and symptoms: Worsening left-sided weakness and facial droop. Nonenhanced brain MRI:There is no evidence of an acute intracranial process in particular no evidence of acute ischemic stroke.This examination they demonstrate previously known large chronic lacunar infarct of left basal ganglia with resultant subtle ex vacuo dilatation of left lateral ventricle. On the cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Well-demarcated round foci of T2 hyperintensity and flair hyperintensity without evidence of surrounding gliosis in the right basal ganglia is consistent with perivascular spaces no clinical significance.The signal void of left internal carotid artery across the skull base and in its supraclinoid segment is smaller in size compared to the right likely secondary to resonance of a large chronic stroke in the left hemisphere.
1.No evidence of acute ischemic change.2.Large chronic left MCA territory basal ganglia lacunar infarct as detailed.3.Small caliber of the left cavernous and supraclinoid internal carotid likely secondary to large chronic left history stroke.4.Unremarkable nonenhanced brain MRI otherwise.