Acute lymphoid leukemia, without mention of having achieved remission(204.00)Clinical question: stroke in pt w/ ALLSigns and Symptoms: acute onset of UE weakness, ptosis, slurred speech MRI of the brainThere is a 30 x 14 mm axial dimension focus of diffusion restriction located in the left centrum semiovale and extending to the subcortical white matter predominantly adjacent to the left frontal lobe extending towards the left parietal lobe. Transmedullary veins in the region are somewhat more prominent and hypointense on susceptibility weighted imaging. On FLAIR imaging there is only subtle signal hyperintensity in the area of diffusion restriction. No sulcal hyperintensities are appreciated on FLAIR MRI.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Findings suggest some mild narrowing along the inferior division branch of the left middle cerebral artery at the distal M1 segment which supplies angular and posterior parietal arteries. It is quite possible this is related to artifact as well.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.Findings are compatible with acute ischemic cerebral infarction involving left centrum semiovale and extending towards the subcortical white matter of the left frontal lobe and to lesser degree left parietal lobe. There is no evidence for hemorrhagic conversion.2.No intracranial cerebral vascular occlusion is appreciated.3.No extracranial cerebrovascular occlusion is appreciated. There is no evidence for carotid or vertebral dissection on the basis of this exam.