Locked in syndrome secondary to embolic stroke involving the vertebrobasilar system, status post embolectomy. There is extensive T2 hyperintensity and restricted diffusion within the bilateral cerebellar hemispheres, particularly, the superior portions. There is also T2 hyperintensity and restricted diffusion within the pons and to a lesser extent the midbrain and medulla. In addition, there are scattered punctate foci of T2 hyperintensity and restricted diffusion within the bilateral occipital lobes and hippocampi. There is patchy T2 hyperintensity and restricted diffusion within the bilateral thalami, right greater than left. There is effacement of the fourth ventricle and cerebral aqueduct, with interval enlargement of the third and lateral ventricles with associated diffuse periventricular white matter T2 hyperintensity, which likely represents transependymal cerebrospinal fluid flow. There is also mild inferior cerebellar tonsillar herniation and effacement of the foramen magnum cerebrospinal fluid spaces and compression of the medulla. There is no evidence of intracranial hemorrhage. There is no midline shift. The vertebrobasilar flow voids are slightly heterogeneous, which may be related to flow or residual thrombus. There is extensive sinonasal fluid and mucosal thickening, as well as a small amount of fluid within the right mastoid air cells, which may be related to intubation. The orbits, skull, and scalp soft tissues are grossly unremarkable.
Extensive recent infarcts involving the posterior circulation territories, including the cerebellum, brainstem, thalami, occipital lobes, and hippocampi, without hemorrhagic conversion. However, the ensuing edema has resulted in obstructive hydrocephalus and mild inferior herniation of the cerebellar tonsils. Discussed with Dr. Ardelt at 8:55 AM on 2/17/16.