Malaise and fatigue. Left-sided weakness. Evaluate for stroke. There is restricted diffusion within the right posterior basal ganglia with associated T2 hyperintensity, compatible with acute infarction, as identified on recent CT. There is associated susceptibility, consistent with new hemorrhage since CT July 14, 2015. There are multiple additional punctate foci of the restricted diffusion within the right basal ganglia and the right MCA watershed territory in the deep white matter. A focus of restricted diffusion within the right inferior frontal cortex (series 501, image 248) is less intense on diffusion weighted imaging, probably subacute. There is a linear area of restricted diffusion within the right posterior parietal cortex (series 501, image 241), possibly artifactual, as no FLAIR abnormality is detected. There is no midline shift or herniation. There is loss of the normal right M2 flow void, best visualized on series 1301, image 15. There is corresponding mild intrinsic T1 hyperintensity in this location.There are additional foci of T2 hyperintensity within the periventricular and subcortical white matter, with no restricted diffusion, probably sequela of chronic microvascular ischemic disease. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Acute infarct within the right basal ganglia now with associated blood products, with multiple additional adjacent foci of restricted diffusion, consistent with punctate infarcts.2.Additional possible subacute infarct in right inferior frontal gyrus.3.There is loss of the normal right M2 flow void, compatible with slow/irregular flow, corresponding to the hyperdense MCA seen on CT. 