word finding difficulty, confusion Multiple restricted diffusion lesions on bilateral frontal lobes and left parietal lobe indicating multiple acute ischemic infarctions.There is no evidence of hemorrhagic lesion on this scan.Underlying brain shows patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Patent Acom artery and right Pcom artery are seen but the left Pcom artery is not shown.There is no evidence of intracranial arterial aneurysm, stenosis or occlusion.
1. Multifocal ischemic foci on bilateral frontal lobes and left parietal lobe without evidence hemorrhagic conversion.2. Normal brain MRARec: Neck MRA or CT angiography of head and neck is recommended for further investigation of extracranial craniocervical arterial system.