Cerebral infarction due to embolism of unspecified cerebral artery [I63.40], Reason for Study: ^Reason: Evaluate for mycotic aneurysm and assess for stroke burden History: L face/arm/leg weakness with neglect Brain MRIThere is large area of restricted diffusion involving the right temporoparietal lobe as well as posterior aspect of insular cortex indicating acute ischemic infarct.Multifocal bihemispheric supra and infratentorial scattered restricted diffusion lesions are again seen, suggesting embolic in nature of multifocal ischemic infarcts.On gradient echo images, bihemispheric scattered susceptibility lesions are seen and some of them are within the area of restricted diffusion, thus may indicate focal areas of hemorrhagic conversion. Other susceptibility lesions are not associated with diffusion restriction lesions and there is no evidence of surrounding edema thus suggest chronic parenchymal petechial hemorrhages or parenchymal calcifications.There is focal encephalomalacia on the left pre central gyrus which indicate chronic ischemic infarction. Several FLAIR/T2 high signal intensity lesions on bilateral centrum semiovale, periventricular white matter and bilateral cerebellar hemispheres indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No significant intracranial arterial luminal stenosis. No intracranial arterial aneurysm. Bilateral Pcom arteries are small but patent. Acom artery is patent.
1. Multifocal bihemispheric acute ischemic infarctions including large right temporo-parietal lobe acute ischemic infarctions.2. There are a couple of susceptibility lesions within the right parietal lobe ischemic infarction lesion which may indicate focal hemorrhagic conversion.3. Multiple scattered susceptibility lesions may indicate chronic hemorrhagic lesions or parenchymal calcifications.4. Minimal to mild non specific small vessel ischemic disease.5. Normal brain MRA 