Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified [R93.0], Reason for Study: ^Reason: further eval findings on CT concerning for stroke History: CT findings concerning for stroke, s/p VA ECMO \T\ myocardial dysfunction Brain MRI:There are multifocal restricted diffusion lesions involving left basal ganglia, bilateral frontal lobe parietal lobe and occipital lobe with peripheral enhancement on gadolinium infusion indicating subacute/acute ischemic infarct. On gradient echo images, there are scattered susceptibility lesions on bilateral hemispheres indicating chronic petechial hemorrhage or parenchymal calcification. In particular, right parietal lobe susceptibility lesions which are associated with acute ischemic infarct represent possible hemorrhagic conversion.The lesions show gyriform high signal intensities on T1 weighted images indicating possible laminar necrosis. Ventricular system is slightly dilated otherwise unremarkable.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells show opacifications.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate extremely attenuated left cervical ICA upto the level of the left cavernous sinus segment. The left MCA and ACA appear to be reconstituted through the left Pcom and Acom arteries.Right ICA, MCAs and ACAs appear to be normal. Vertebrobasilar system appears to be normal.Pituitary MRIThe pituitary gland is normal in size, morphology, signal intensity and enhancement. There is no hypo-enhancement or signal abnormality suggestive of neoplasm. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable.
1. Subacute/acute ischemic infarctions on bilateral hemispheres as described above with hemorrhagic conversion on the right parietal lobe lesion.2. Near complete occlusion of the cervical segment of the left ICA with reconstitution of the distal left ICA at the level of cavernous sinus segment.3. Normal pituitary gland MRI.