Unspecified cerebral artery occlusion with cerebral infarction. Dysarthria There are several punctate foci of diffusion restriction present in the left middle frontal gyrus adjacent to the precentral sulcus as well as in the left precentral gyrus lateral to the hand motor area.There is encephalomalacia present involving the left superior frontal gyrus and left cingulate gyrus anteriorly in an area of a prior infarction. There is associated susceptibility effect within this focus of encephalomalacia. On the 4/7/2013 exam there is diffusion restriction within this focus of encephalomalacia.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.T2 and FLAIR hyperintense punctate lesions are present in the brainstem and thalami.Punctate foci of signal loss on susceptibility imaging are present in the pons, midbrain and basal ganglia.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and 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.There are several microinfarcts present in the left frontal lobe at the posterior most aspect of the left middle frontal gyrus and in the left precentral gyrus. The location could account for dysarthria based on the location of the motor tongue area.2.There is encephalomalacia involving the left superior frontal gyrus and left cingulate gyrus where there was previously cerebral infarction in the subacute stage in April3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Punctate lesions in the thalami and brainstem are compatible with lacunar infarcts.5.Findings are compatible with a few microhemorrhages in the brainstem and basal ganglia which is a distribution suggestive of hypertension