Reason: presence of small vessel ischemic disease History: transient aphasia MRI BRAIN: There is an area of restricted diffusion in the left thalamus, consistent with an acute infarct. Chronic infarcts are present in the right posterior frontal lobe extending to the operculum, left middle frontal gyrus and left inferior cerebellar hemisphere with associated areas of susceptibility, likely reflecting hemosiderin deposition. There are linear areas of mild diffusion hyperintensity just anterior to the infarct in the right frontal lobe without corresponding low signal on the ADC map, possibly representing subacute ischemia. T1 hyperintensity along the anterior aspect of the infarct in the right frontal lobe is consistent with laminar necrosis. Additional areas of encephalomalacia are noted in the right insular cortex in addition to the right anterior and posterior temporal lobe. There is no intracranial mass. There is global parenchymal volume loss. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. Partially empty sella is incidentally noted. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. There is partial opacification of the mastoid air cells, right greater than left. Bilateral lens implants are noted.MRA BRAIN: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are normal in course and caliber. The posterior cerebral arteries, vertebral arteries and basilar artery are patent. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: The left common carotid artery originates from the brachiocephalic artery, which is a normal variant. The common and cervical internal carotid arteries are normal in course and caliber. There is mild atherosclerotic plaque at the left internal carotid artery origin, but no significant stenosis. The vertebral artery origins are widely patent. There is no evidence of flow-limiting stenosis or aneurysm.
1. Small focus of of restricted diffusion in the left thalamus is consistent with an acute infarct.2. Linear areas of mild diffusion hyperintensity just anterior to the chronic infarct in the right frontal lobe without corresponding low signal on the ADC map may represent subacute ischemia. 3. Multiple supra and infratentorial chronic infarcts.4. No evidence of flow-limiting stenosis or aneurysm.Findings communicated to Dr. Choudhury at time of dictation.