69 years, Female, evaluate for infarct. Left face and arm weakness with sensory loss. There has been slight evolution of previously seen acute infarct in the right frontal lobe. There are new foci of restricted diffusion with T2/FLAIR hyperintensity adjacent to the aforementioned infarct as well as involving the right posterior temporal and occipital subcortical white matter consistent with acute infarcts. Additional patchy foci of T2/FLAIR hyperintensity involving the bilateral subcortical and periventricular white matter are again seen which are nonspecific but compatible with moderate chronic small vessel ischemic disease and perhaps in part related to the right ICA occlusion. Tiny nonspecific focus of susceptibility compatible with microhemorrhage in the right posterior frontal corona radiata. T2 hyperintense focus involving the left pons is compatible with perivascular space, less likely lacunar infarct.Perfusion images demonstrate prolonged mean transit times and in much of the right cerebral hemisphere compatible with right ICA occlusion. There is asymmetrically increased cerebral blood flow in the right anterior cerebral hemisphere including the basal ganglia.No intracranial mass or mass effect. Ventricles are normal in size. There is a punctate focus of enhancement involving the right paracentral lobule which may be related to subacute infarct, axial series 1201 image 26. There is otherwise no abnormal parenchymal or meningeal enhancement. Absent right internal carotid artery flow-void is again seen. Calvarium and extracranial soft tissues are grossly unremarkable.
1. Slight evolution of previously seen punctate right frontal subcortical white matter infarct. Compared to 8/19/2016 there are new punctate infarcts in the right cerebral hemisphere including the right posterior frontal, posterior temporal, and occipital white matter. There is also a punctate focus of enhancement likely representing a subacute infarct in the right paracentral lobule.2. Absent right internal carotid artery flow-void consistent with occlusion as seen on prior CTA. Perfusion images demonstrate associated prolonged mean transit time in the right cerebral hemisphere. Areas within the right frontal lobe and right basal ganglia demonstrates relatively increased/preserved cerebral blood flow.