Reason: new ischemia History: left sided neglect, right gaze preference The CSF spaces are appropriate for the patient's stated age with no midline shift. There are small foci of diffusion restriction present in the right middle cerebral artery territory in the right centrum semiovale as well as right postcentral gyrus and right supramarginal gyrus.A focus of high signal on diffusion weighted imaging in the left inferior parietal lobule extending to the adjacent temporal lobe is associated with a gyriform T1 signal hyperintensity but not diffusion restriction on ADC maps. It is associated with some gyriform susceptibility effect.There is encephalomalacia involving the right occipital lobe.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are similar signal changes in the brainstem and thalami.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is reversal of the normal cervical curvature present.
1.There are several small foci of acute infarction distributed in the right middle through artery territory as indicated above2.a focus of late subacute infarction is suspected in a left inferior parietal lobule.3.encephalomalacia in the right occipital lobe present probably related to an old focus of infarction.4.Periventricular and subcortical white matter changes of a moderate degree and signal changes in the brainstem and thalami are nonspecific. At this age they are most likely vascular related. 