Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: pre-opSigns and Symptoms: aphasia MRI of the brainThere is diffusion restriction involving the left frontal and parietal lobes as well as the insular cortex and the posterior superior aspect of the left temporal lobe predominantly in the territory of the superior division of the left MCA but including angular artery territory as well. There is a microhemorrhage present along the left parietal lobe within the area of infarction.There is midline shift present with 2mm shift of the septum pellucidum towards the right. There is mild displacement of the uncus medially.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of cavum septum pellucidum and cavum vergaeNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is a paucity of vasculature in the left middle cerebral artery territory.The visualized portions of the paranasal sinuses demonstrate some scattered opacities in the mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is mildly compromised due to patient motion.MRA brain:MRI examination is mildly degraded due to motion artifact.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries. There is occlusion of the left MCA at the bifurcation with sparing of the left anterior temporal artery and left prefrontal artery.There is no evidence for intracranial aneurysm.The left vertebral artery is hypoplastic distal to the origin of the left posterior inferior cerebellar artery.The anterior communicating artery is identified. There appears to be fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment and a medium sized left posterior communicating artery.
1.Subacute infarction along the left MCA territory associated with mild midline shift, mild uncal displacement medially and a couple microhemorrhages.2.Occlusion of the left MCA at the bifurcation with sparing of the left anterior temporal artery and left prefrontal artery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Examination is mildly degraded on some of the sequences due to patient motion which may obscure more subtle abnormalities.