67-year-old with history of recent infarct presenting with worsening mental status. Evaluate for worsening infarct. Again seen is restricted diffusion in the left parietal, occipital, and temporal lobes. The area of restricted diffusion is slightly decreased in size compared to the prior exam.There is confluent increased T2 signal within the left parieto-occipital, temporal lobes as well as the subcortical white matter of the posterior left frontal lobe, splenium of the corpus callosum, and left occipital lobes. There is some local mass effect in the left parieto-occipital and posterior temporal lobes with effacement of the sulci and the atrium of the left lateral ventricle, but this is also slightly decreased compared to prior.Again seen is gyriform increased T1 signal in the left parieto-occipital and posterior temporal lobes, similar to prior. In addition, there remains enhancement within and around the infarct clear which has become more complete and confluent.There are scattered foci of susceptibility in the right frontal and left parietal lobes at the sites of previously noted metastases. Some the areas of gyriform T1 increased signal in this region also have susceptibility artifact compatible with hemorrhage. No significant extra-axial collection.The postcontrast images are limited by patient motion. Again seen is a focus of enhancement in the right frontal lobe measuring 7 x 6 mm as well as in the right occipital lobe measuring 8 x 6 mm compatible patient's known metastasis. Within the limitations of the study, these are not significantly changed from prior.The orbits are unremarkable. Paranasal sinuses are clear. Trace bilateral mastoid air cell fluid.
1. Redemonstration of an evolving subacute left parieto-occipital and temporal lobe MCA distribution infarct. The restricted diffusion in the core of the infarct is slightly decreased compared to prior and there is overall less associated mass effect compatible with the expected evolution of a subacute infarct. No new areas of ischemia. 2. Right frontal and occipital enhancing subcortical nodules compatible with previously known metastases are not significantly changed from prior within the limits of this motion degraded exam. The signal abnormality associated with the infarct now obscures the previously noted left parieto-occipital metastases.