50-year-old female with new visual field defect, evaluate for stroke.. There is restricted diffusion involving the right posterior frontal corona radiata consistent with acute infarct. There is mild enhancement. There is a larger area of T2 hyperintensity and mild volume loss involving the right occipital lobe extending into the right medial temporal lobe consistent with late subacute to chronic right PCA infarct. There is T1 hyperintensity involving the occipital cortex consistent with laminar necrosis. There is also enhancement associated with this PCA infarct. Additionally, there is an area of gliosis without restricted diffusion or enhancement involving the right paracentral lobule including the post central gyrus. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. The right internal carotid artery flow void is severely diminutive compatible with occlusion or high-grade stenosis.Sella and orbits are grossly within normal limits. Paranasal sinuses are clear. There is mild opacification of the left mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Acute infarct in the right posterior frontal corona radiata.2. Large late subacute to chronic infarct in the right posterior cerebral artery territory involving the right occipital and medial temporal lobes.3. Chronic infarct in the right parietal lobe involving the medial aspect of the right post central gyrus.4. Severely diminished flow-void of the right internal carotid artery which may be due occlusion or high grade stenosis. Suggest MRA or CTA for further evaluation.Dr. Ali discussed findings with on-call opthalmology resident Dr. Gupta on 5/2/2015 at 1700 hrs.