Left facial droop and dysarthria, clumsy left hand, and unsteady gait. MRI: There are patchy areas of restricted diffusion and high T2 signal in the right basal ganglia, corona radiata, insula, and anterior temporal lobe. There are a few scattered foci of T2 hyperintensity in the cerebral white matter without associated restricted diffusion, which may be related to chronic small vessel ischemic disease. There is diffuse prominence of the pial vasculature in the affected right middle cerebral artery territory. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA: There is significant steno-occlusive disease involving the proximal right middle cerebral artery with paucity of flow related enhancement in the distal branches. The right vertebral artery appears to be hypoplastic. The other components of the circle or Willis appear to be intact, including bilateral fetal-type posterior cerebral arteries. There is no evidence of cerebral aneurysms.
Acute right middle cerebral artery territory infarct associated with significant steno-occlusive disease involving the proximal right middle cerebral artery with paucity of distal collateral vessels, but no evidence of hemorrhagic transformation or midline shift. Discussed with Dr. BERNARD at 4:30 PM on 1/16/15.