Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: ischemic stroke History: ischemic stroke Brain MRIMotion artifacts degraded image quality.Previously seen left thalamic hemorrhage and IVH especially on the left lateral ventricle occipital horn are again demonstrated. Restricted diffusion seen on DWI of the thalamic lesion can be considered as usual characteristics of acute hemorrhage especially in early stage. Lack of susceptibility effects on gradient echo images indicate hemorrhagic conversion from acute ischemic lesion less likely but still is a possibility.Minimal mass effect is associated with the lesion, however, there is no identifiable midline shift.There is no other acute ischemic or hemorrhagic lesion on this scan.Encephalomalacia on the left inferior parietal lobule is seen indicating chronic ischemic lesion.Underlying brain shows patch high signal intensity lesions on bilateral centrum semiovale and periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The mastoid air cells are clear.There is opacification of the right maxillary sinus the subtle mass like effects. Differential diagnosis include intra sinus mass lesion including tumorous condition such as inverted papilloma, inflammatory polyp or fungal lesion. Dedicated imaging study can be considered for further imaging evaluation if clinically necessary.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) tandem stenosis of proximal basilar arteryand mid portion of the left MCA M1 segment where the left anterior temporal branch origin stenosis (about 30%). In addition, the left MCA angular branch appears to be diminutive indicating possible severe luminal stenosis or related to prior stroke.There is no evidence of intracranial arterial aneurysm.Above described findings are consistent with intracranial arterial atherosclerosis.
1. Left thalamic ICH with IVH especially in the left lateral ventricle occipital horn,2. No evidence of other acute ischemic lesion.3. Intracranial atherosclerosis involving basilar artery and the left MCA as described above.4. Mass like lesion on the right maxillary sinus, dedicated imaging study can be considered if clinically indicated. 