50 years, Female, left lip droop, dysarthria right lower extremely weakness. Examination is motion degraded. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is T2/FLAIR hyperintensity with volume loss in the right frontal lobe extending into the right basal ganglia, insula, and right superior temporal gyrus consistent with encephalomalacia in the right middle cerebral artery territory. There is ex vacuo dilatation of the right lateral ventricle; no hydrocephalus. There is T2 hyperintensity extending along the right cerebral peduncle with volume loss consistent with Wallerian degeneration. There is susceptibility effect compatible with chronic hemorrhage in the right basal ganglia. There is additional mild patchy T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as the pons compatible with mild chronic small vessel ischemic changes. Major flow-voids are preserved aside from the right middle cerebral artery, which was better evaluated on recent CT angiogram.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Calvarium and extra cranial soft tissues are unremarkable.
1. Chronic right middle cerebral artery territory infarct. No evidence of acute infarct.2. Evidence of chronic hemorrhage in the right basal ganglia.