Reason: stroke History: acute aphasia MRI brain:There are numerous supratentorial and infratentorial bilateral foci of diffusion restriction with large regions of restricted diffusion in the right frontal and left occipital lobes. Right frontal and right parietal foci areas of diffusion restriction correspond to findings on recent CT. Hyperdensity within the right frontal lesion demonstrates susceptibility, likely reflecting petechial hemorrhage. A few of these lesions have increased FLAIR signal, although many do not. Numerous punctate foci of susceptibility are present bilaterally, many of which are not associated with areas of diffusion restriction. No frank hematoma is evident. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses. Opacification of the mastoid air cells bilaterally is likely related to intubation.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. There is a hypoplastic A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.
1.Numerous bilateral foci of diffusion restriction in the anterior and posterior distributions compatible with acute infarcts and favoring embolic etiology.2.Multiple foci of susceptibility effect within the infarcts are compatible with petechial hemorrhages. No frank hematoma formation is evident. Numerous additional bilateral foci of punctate susceptibility not associated with areas of diffusion restriction likely represent chronic microhemorrhages, which may be related to thrombotic microangiopathy or anticoagulation among other causes. No significant mass effect, midline shift, or herniation.3.No significant stenosis in the intracranial vasculature. No significant stenosis in the neck vasculature.