Clinical question: 61 yo with h/o CML, assess for CVA, assess for interval change in chloromaSigns and Symptoms: ataxia, aphasia. There are several punctate foci of diffusion restriction present in the left centrum semiovale and subcortical white matter. These are associated with T2 and FLAIR signal hyperintensity. They were not present on the 10/20/2008 examOn FLAIR imaging there is serpiginous signal hyperintensity present in the sulci of the left temporal lobe extending to the left inferior parietal lobule suggestive of signal hyperintensity within the left angular artery.The caliber of the left internal carotid artery appears smaller than its right-sided counterpart on on the postcontrast fat-sat axial T1 images as well as the post gadolinium SPGR T1 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a burr hole present in the right parietal bone just lateral to the right some central lobule . There is a small focus of encephalomalacia present at the right some centrilobular anteriorly,There are punctate foci of signal loss on susceptibility weighted imaging in the right periventricular white matter with a larger focus of susceptibility effect in the right frontal lobe involving the anterior aspect of the subcentral lobule and the adjacent subcortical white matter. There are additional punctate foci of signal loss and susceptibility weighted imaging in the subcortical white matter of the right temporal lobe.No abnormal enhancing 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 demonstrate mucous retention cysts in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Findings are suspicious for punctate foci of acute cerebral infarction involving the left centrum semiovale which could intensely suggest vascular compromise in the left hemispheric territory.2.Findings raise the question of slow flow along the left angular artery (which could affect the left inferior parietal lobule). Please correlate with potential relevant clinical symptoms. If clinically appropriate a perfusion study and an the MRA of the brain or a CTA of the brain may be helpful to further evaluate this.3.The caliber of the left internal carotid artery appears smaller than its right-sided counterpart on some of the images. If clinically appropriate MRA of the neck or CTA of the neck may be of benefit to further evaluate this for possible carotid stenosis..4.Small focus of encephalomalacia and surrounding microhemorrhages in the adjacent right temporal lobe and frontal lobe white matter is probably related to the patient's prior history of chloroma and associated treatment.5.An alphanumeric page was with callback was sent to pager 1551 at the time of this dictation. Ashley called back at 9:15 am and the findings were discussed.