Malaise and fatigue. New stroke. Left-sided weakness MRI of the brainDiffusion restriction is present along the right precentral gyrus extending into the right middle frontal gyrus with a punctate foci of diffusion restriction along the subcortical white matter of the right superior frontal gyrus extending to the right cingulate gyrus. Additional punctate foci of diffusion restriction are present in the right inferior parietal lobule. These foci of diffusion restriction are associated with flair and T2 signal hyperintensities.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The right middle cerebral artery superior division is the dominant division.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left posterior communicating artery is tiny whereas the right is small The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.Findings are compatible with subacute foci of infarction involving portions of the superior division of the right middle cerebral artery and to a lesser degree right anterior cerebral artery as detailed above. There is no evidence for hemorrhagic conversion appreciated2.No evidence for intracranial or extracranial cerebrovascular occlusive disease.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 