Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: ams, history of malignancy, history of embolic strokes The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is redemonstrated in the posterior aspect of the right temporal lobe extending into the adjacent occipital lobe.Another focus of encephalomalacia is present along the medial and inferior aspect of the left cerebellar hemisphere. This was also present on the previous examThere are some small cortically based foci of diffusion weighted signal hyperintensity located at the focus of encephalomalacia in the right posterior temporal lobe additionally there are punctate foci of signal hyperintensity on the diffusion-weighted imaging in the centrum semiovale bilaterally in the left middle frontal gyrus and in the left precuneus. These are associated with low signal on ADC maps.There is a moderate degree of periventricular and subcortical confluent and punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are several punctate foci of susceptibility effect in the subcortical white matter as well as in the thalami bilaterally and the brainstem and to a lesser degree cerebellar hemispheres and basal ganglia. They're more densely populated in the thalami.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.There is redemonstration of a lipoma along the frontal scalp tissues just anterior to the coronal suture.
1.There are multiple punctate foci of diffusion restriction suggesting punctate infarctions scattered in the supratentorial brain as detailed above. This could potentially represent a mild shower of emboli2.Redemonstration of foci of encephalomalacia centered in the right parietal lobe and inferior semilunar lobule of the left cerebellar hemisphere3.Multiple microhemorrhages are present in a distribution which includes dominantly brainstem and thalami but also elsewhere is suspicious for hypertensive cause 4.Periventricular and subcortical white matter changes of a moderate to marked degree are nonspecific. At this age they are most likely vascular related. 