Concern for acute ischemic stroke: right arm paralysis. There is an area of restricted diffusion with corresponding high T2 signal in the left precentral gyrus that measures up to approximately 20 mm. There also appears to be a small area of restricted diffusion in the white matter adjacent to the left frontal horn and linear restricted diffusion in the right parietal lobe. There is a right transoccipital ventricular catheter that terminates in the left lateral ventricle. There are bilateral cerebral convexity subdural effusions, which measure up to 6 mm in width on the right and 12 mm in width on the left. The ventricular system is unchanged in size. Artifact from the reservoir obscures surrounding structures. There is fluid signal within the bilateral mastoid air cells.
1. Acute infarction in the left precentral gyrus and perhaps small smaller recent infarcts in the left frontal and right parietal lobes superimposed upon a background of chronic small vessel ischemic white matter disease.2. Bilateral cerebral convexity subdural effusions, which may indicate chronically low intracranial pressure. 3. Unchanged shunted ventricular system.Discussed with Dr. Stern at 1:00 PM on 4/22/15.