57 years Female (DOB:7/9/1959)Reason: stroke History: aphasia and right sided weaknessPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the previous examination patient developed new foci of diffusion restriction in the left middle frontal gyrus and along the left subcentral lobule, adjacent pre and postcentral gyri and lateral aspect of the postcentral gyrus. The patient's previous foci of infarction in the left precentral gyrus have evolved.. There is redemonstration of small foci of encephalomalacia in the watershed distribution between the left anterior and middle cerebral artery territoriesThere is T2 signal hyperintensity within the petrous segment of the left internal carotid artery. There is FLAIR signal hyperintensity present in the left sylvian fissure and a couple branches of the middle cerebral artery.Normal vascular flow voids are present in the distal right carotid arteries, distal bilateral vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.New foci of acute infarction are present in the left middle cerebral artery territory involving the left middle frontal gyrus, left subcentral lobule extending to adjacent pre and postcentral gyri as well as left postcentral gyrus.2.Findings raise the question of new occlusion of a couple branches of the left middle cerebral artery at the M2 and M3 segments in the sylvian fissure which correspond to the areas of infarction. If clinically appropriate CT angiogram or an MR angiogram may be helpful to further evaluate this.3.There is redemonstration of watershed distribution foci of infarction in the left hemisphere which are in a more chronic stage on the current exam.4.Findings suggest left internal carotid artery occlusion.