74-year-old female with worsening mental status, concern for CVA evolution on CT. Evaluate for possible new ischemia.. Since the prior MRI there is increased restricted diffusion involving the subcortical and periventricular white matter predominantly within the left parietal lobe and temporal lobe as well as minimally within the left occipital lobe with corresponding increased T2/FLAIR signal in these regions compatible with progressing ischemic infarcts in the left MCA territory. There is minimal effacement of the occipital horn of the left lateral ventricle without midline shift; the temporal horns are not dilated. There is a background of confluent bilateral subcortical and periventricular white matter T2/FLAIR hyperintensity consistent with extensive chronic small vessel ischemic disease. No susceptibility signal is noted to suggest hemorrhagic conversion. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Progressing ischemic infarcts within the left MCA territory. No evidence of hemorrhagic conversion. Minimal mass effect is noted with no midline shift or herniation.2. Extensive chronic small vessel ischemic disease.