39 years, Male, left-sided weakness, left facial droop. Previously seen infarcts in the right inferior parietal lobule as well as a left anterior corpus callosum have evolved in the interval. There has however been development of restricted diffusion consistent with acute infarct involving the right parietal lobe anterior, superior, and medial to the previously seen infarct. The acute infarct also extends into the right posterior frontal lobe, including inferior extension to the right frontal operculum, as well as the right insular cortex. There is also a punctate focus of restricted diffusion involving the left mid body of the corpus callosum which is also new since prior. Extensive patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter is also again seen, which may reflect small vessel ischemic disease, but is unusual for age. Chronic blood products involving the left anterior corpus callosum again seen. Chronic lacunar infarct involving the right pons is again evident. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. Major flow-voids are preserved. Small left maxillary mucus retention cyst. Mastoid air cells are opacified. Calvarium and extracranial soft tissues are otherwise unremarkable.
Multiple infarcts of different ages are seen. There is evolution of prior right inferior parietal and left callosal genu infarcts and development of acute infarcts in the right parietal and posterior frontal lobes, right insular cortex, as well as the body of the corpus callosum on the left. Additional chronic infarcts as described above.