History of anemia recently admitted for dysarthria and found to have left MCA sub-acute ischemic infarct. Brain MRI: There is predominantly gyriform T2 hyperintensity and swelling with associated restricted diffusion involving large areas of the inferior division of the left middle cerebral artery territory, predominantly involving the lateral left temporal lobe, as well as a small area of involvement in the lateral left occipital lobe. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There appears to be paucity of flow related enhancement to a branch of the inferior division of the left middle cerebral artery. However, there is no evidence of significant steno-occlusive lesions at the circle of Willis. There may be a mildly prominent infundibulum of the left posterior communicating artery, but there is no evidence of saccular aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. In particular, there is no evidence of dissection. There is a two vessel aortic arch, which is an anatomic variant. The neck soft tissues appear to be grossly unremarkable.Neck MRV: There is no evidence of cerebral venous filling deficits.
1. Subacute infarction involving large areas of the inferior division of the left middle cerebral artery territory without evidence of hemorrhagic transformation or midline shift.2. Apparent paucity of flow related enhancement to a branch of the inferior division of the left middle cerebral artery. Otherwise, no evidence of significant steno-occlusive lesions at the circle of Willis. 3. No evidence of dissection in the cervical arteries.4. No evidence of cerebral venous thrombosis.