Stroke: left side weakness. MRI: There are cortical and subcortical areas of high T2 signal and mildly restricted diffusion in the right frontal and parietal lobes, including the precentral and postcentral gyri. The largest area in the right middle frontal gyrus measures up to at least 25 mm, where there are small areas of susceptibility effect. There is a large area of encephalomalacia in the left occipital and medial temporal lobes with ex vacuo dilatation of the left lateral ventricle, superimposed upon diffuse cerebral volume loss. There is a background of scattered cerebral and pontine white matter T2 hyperintensity. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an apparent focal deficit of flow related enhancement in the insular branch and distal left middle cerebral artery M1 segment. There also appears to be focal steno-occlusive disease of the distal left middle cerebral artery M1 segment. There are multiple focal areas of markedly diminished flow related enhancement in the left vertebral artery. There is paucity of flow related enhancement of the right posterior cerebral artery beyond the very proximal segment arising from the posterior communicating artery. There is loss of flow related enhancement in the left posterior cerebral artery P2 segment. The basilar artery appears to be intact. There appears to be intact flow related enhancement in the proximal anterior cerebral arteries, aside from an apparently hypoplastic left A1 segment. The bilateral intracranial interval carotid arteries appear to be intact. There is no evidence of aneurysms.
1. Subacute infarcts in the right frontal and parietal lobes, with evidence of petechial hemorrhages in the right frontal lobe.2. Chronic left posterior cerebral artery territory infarct.3. A background of scattered cerebral and pontine white matter T2 hyperintensity likely represents chronic small vessel ischemic disease. 4. Apparent focal steno-occlusive disease of a proximal right middle cerebral artery and insular branch and distal left middle cerebral artery M1 segment.3. Significant steno-occlusive lesions involving the bilateral posterior cerebral arteries and left vertebral artery.