 There are new areas of restricted diffusion along the right superior frontal sulcus and more inferiorly white matter of the right frontal lobe. There are also multiple new punctate foci of restricted diffusion in the white matter of the left frontal lobe. Restricted diffusion in the right occipital and parietal lobes is less conspicuous compared to the prior MRI. However, restricted diffusion in the superior cortex of the left parietal lobe has increased in size now extending more anteriorly along the cingulate gyrus. There is associated T2/FLAIR hyperintensity in these regions of ischemia. There is no evidence of hemorrhagic conversion.The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD
1.New areas of acute ischemia in the white matter of the left frontal lobe, left superior frontal sulcus and along the cingulate gyrus. Additional areas of subacute supratentorial ischemia are unchanged with no evidence of hemorrhagic conversion.2.Multifocal intracranial arterial luminal stenoses involving the bilateral MCAs, ACAs, and potentially the left vertebral artery. Please also refer to the report for the conventional angiogram from 9/1/2016, a more sensitive exam for evaluation of the vasculature.