Female, 63 years old, with cerebral infarction. MRI brain:A segment of cortical restricted diffusion is evident within the right precentral gyrus. Several foci of restricted diffusion are also seen within the left corona radiata immediately adjacent to the lateral ventricle. The prior MRI demonstrated diffusion restricting lesions in similar areas as well.Severe encephalomalacia of the left basal ganglia, insula, operculum and periventricular white matter is seen with ex vacuo dilatation of the left lateral ventricle. Mild encephalomalacia affects the left parietal lobe and both occipital lobes. There is evidence of multiple scattered small chronic infarcts in the cerebellum. Near confluent FLAIR hyperintensity is demonstrated through much of the remaining left MCA territory, and to a lesser extent in the right periventricular white matter, both sides showing interval progression. No significant generalized edema or mass effect is seen. In fact, there is a moderate degree of generalized parenchymal volume loss. The left basal ganglia shows evidence of hemosiderin staining compatible with chronic microhemorrhage deposition. A few additional scattered small foci of chronic microhemorrhage are also seen. No evidence of acute intracranial hemorrhage is demonstrated.MRA brain:Atherosclerotic irregularity of the left cavernous ICA and left M1 MCA is seen without definite focal high-grade stenosis. The more distal left MCA branches are attenuated relative to the right, and more so than that seen on the prior MRA. No high-grade focal stenosis is detected within the visualized right MCA branches. The ACAs are likewise unremarkable. No high-grade stenosis or occlusion is suspected within the visualized posterior circulation vessels.MRA neck:Common origin of the brachiocephalic and left common carotid arteries is seen. The origins of the great vessels are patent. The carotid arteries take a tortuous, retropharyngeal course, though no significant carotid stenosis is detected by NASCET criteria. Likewise, no evidence of significant stenosis or occlusion is seen within the vertebral vessels of the neck.
1.Small areas of acute ischemia are identified involving the right precentral gyrus and the left periventricular corona radiata. Both of these territories demonstrated ischemic lesions on the prior examination as well.2.Evidence of extensive chronic ischemic injury is seen, particularly affecting the left MCA distribution, with smaller chronic lesions scattered elsewhere throughout the cerebral hemispheres. Findings compatible with chronic microvascular ischemia are also noted.3.MRA imaging of the head demonstrates a generalized attenuation of MCA vessels on the left compatible with chronic ischemic injury. No other high-grade stenosis or occlusion is suspected.4.MRA imaging of the neck shows no evidence of significant vascular compromise.