Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: evaluate for changes from prior MRI History: continued sleepiness and concern for hx of seizure. There is no new acute ischemic or hemorrhagic lesion on this scan.Some restricted diffusion lesions are more conspicuous on today's scan which is not that unusual finding. Previously seen multifocal ischemic lesions with surrounding edema including bilateral occipital lobe lesions are again seen and more conspicuous than prior scans on FLAIR/T2 images.On T1 weighted images, those lesions show high signal intensity with somewhat gyriform in configuration and low signal intensity on T2 images indicating interval development of hemorrhagic conversion or possible early laminar necrosis. Although those lesions do not show significant susceptibility artifacts, possibility of hemorrhagic conversion cannot be excluded.Follow up MR imaging and/or brain CT scan may help to exclude possibility of parenchymal hemorrhage.Subtle punctate susceptibility lesions on bilateral occipital lobe lesions are again seen, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no significant mass effect, midline shift. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. High signal intensity on T1 and low signal intensity on T2 within previously shown ischemic lesions suggest possibility of development of hemorrhagic conversion on previously recognized ischemic infarctions or early development of laminar necrosis.2. No evidence of new ischemic or hemorrhagic lesion.