cerebral vascular accident. Lung cancer. Possible metastases There is encephalomalacia present involving the right basal ganglia and much of the right middle cerebral artery territory including predominantly frontal lobe and parietal lobe. There is associated ex vacuo effect on the right lateral ventricle. There is susceptibility effect present in the region of the right basal ganglia and in the region of the right frontal and parietal lobes. There is loss of volume and associated signal change along the right thalamus, right cerebral peduncle and right pons.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There are serpiginous foci of enhancement present in the right hemisphere which are suspected to represent slow flow in the territory of cerebral infarction.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 left vertebral artery is larger than the right vertebral artery. There appears to be fetal origin of the right posterior cerebral artery and a small right A1 segment.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.In general the marrow signal is low in intensity but does not appear to enhance.
1.Findings are compatible with an old right middle cerebral artery territory cerebral infarction. There is associated Wallerian degeneration.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for brain metastases.4.Examination is degraded by patient motion. This may obscure more subtle abnormalities such as a small metastasis.5.Low marrow signal is a nonspecific finding which can be seen with chronic disease as well as many other entities including myeloproliferative disorder, lymphoproliferative disorder or anemia.