64-year-old male with acute on chronic left hemiparesis. Evaluate for new acute ischemic infarct. Note that this is an incomplete exam as the patient refused to continue. In particular, there are no susceptibility/gradient echo images.Within the right basal ganglia is an area of diffusion restriction compatible with an acute ischemic infarct. There is also restricted diffusion to a lesser degree within the right corona radiata and the left genu of the corpus callosum which likely represent somewhat older acute to subacute infarcts. There are additional patchy areas of periventricular and subcortical T2/FLAIR hyperintensities with additional FLAIR signal abnormalities within the left basal ganglia and diffusely in the brainstem which do not restrict on diffusion-weighted images and are compatible with chronic small vessel ischemic disease. There is no significant mass effect, midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Findings compatible with an acute ischemic infarct involving the right basal ganglia. There is no significant mass effect, midline shift or herniation.2.Somewhat lesser degree of restricted diffusion involving the right corona radiata and the left corpus callosum probably represent older late acute to subacute infarcts.3.Additional patchy areas of chronic small vessel ischemic disease elsewhere in a periventricular and subcortical distribution.Findings relayed to the Neurology service physician, Dr. Del Brutto (pager 1706) at the time of this final entry by Dr. Veronesi of the Radiology service.