Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: R MCA History: Left sided weakness. Brain MRIRestricted diffusion on the right insular, right frontal lobe, right temporal lobe anterior aspect, right globus pallidus, right internal capsule posterior limb, and right cerebral peduncle indicating acute ischemic stroke. There are surrounding edema with mass effects with effacement of the right lateral ventricle. There is no evidence of midline shift.Posterior aspect of the ischemic stroke lesion shows curvilinear susceptibility artifacts on Gradient echo images which likely represent cortical veins which were displaced due to local mass effects instead of hemorrhagic conversion. There is no evidence of hemorrhagic conversion. There are multifocal encephalomalacia at the right temporo-occipital lobe and left centrum semiovale indicating chronic stroke. The cranial-cervical junction are normal. Mucosal thickenings on the right maxillary sinus and ethmoid sinus.Opacifications on the right mastoid air cells.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate near total occlusion of the right MCA proximal M1 segment with minimal forward flow through a very tiny vascular structure which most likely represent anterior temporal branch. There are multifocal luminal narrowings on bilateral PCA P1 segments and left MCA M2 segment indicating atherosclerosis.There is no evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate luminal irregularities especially on the right extracranial ICA without evidence of luminal stenosis indicating possible fibromuscular dysplasia. Bilateral vertebral artery ostia appear to show mild to moderate (less than 50%) luminal stenosis. However, there is no evidence of significant (more than 50%) luminal narrowing on bilateral CCAs, and left extracranial ICA. Bilateral cervical vertebral arteries appear to be within normal limits. Bilateral subclavian arteries appear to be normal.
1. Right MCA territorial acute ischemic infarction involving right frontal lobe, right frontal operculum, right anterior temporal lobe, right insular, right basal ganglia, and right cerebral peduncle without evidence of hemorrhagic conversion.2. Near total occlusion of the right MCA at the proximal M1 segment with evidence of intracranial atherosclerosis.3. Multifocal chronic encephalomalacia at the right temporo-occipital lobe and left centrum semiovale.4. Irregular right extracranial ICA lumen indicating possible fibromuscular dysplasia. 