Diagnosis: Other specified disorders of muscle. Cerebral infarction, unspecifiedClinical question: stroke evaluation.Signs and Symptoms: L-sided facial droop and slurred speech, s/p thrombectomy There is a area of diffusion restriction present involving the right middle frontal gyrus which extends into the right precentral gyrus, right inferior frontal gyrus and a small portion of the adjacent right insular cortex. It measures approximately 55 x 39 mm axial dimensions. A couple punctate foci of diffusion restriction present along the right cuneus and precuneus. Another punctate focus of diffusion restriction is present in the gray matter at the left superior frontal sulcus.Within the right middle frontal gyrus there is a small focus of susceptibility effect without T1 signal hyperintensity. It measures approximately 9 mm x 4 mm on axial T2 imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR hyperintense lesions are also present in the brainstem. These are also present on the prior exam from 2010.There is fusiform dilation of the basilar artery.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Subacute infarction involving the right frontal lobe with a small focus of hemorrhage.2.A couple punctate foci of microinfarct are present in the right cuneus, right precuneus and the left frontal lobe.3.Fusiform mild aneurysmal dilation of the basilar artery.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. These were also present on the 2010 exam.5.Patchy lesions in the brainstem are also likely vascular related and were also present on the previous exam from 2010