Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: 24 hr post L MCA strokeSigns and Symptoms: stroke MRI of the brainThere is a focus of diffusion restriction present involving left inferior frontal gyrus, left insular cortex and left middle frontal gyrus with some extension into the lateral aspect of the left precentral gyrus and a small component in the left inferior parietal lobule supramarginal gyrus. There are associated FLAIR and T2 signal changes. There is a focus of susceptibility effect present along the left inferior frontal gyrus anteriorly. This focus of susceptibility measures 18 x 9 mm axial dimensions on the T2 axial images.A small focus of encephalomalacia is present along the right occipital lobe the lower portion of the cuneus and region measuring approximately 15 x 20 mm in sagittal dimensions.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal 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 mucosal thickening in the right maxillary sinus associated with a small right maxillary sinus. There is depression of the floor of the right orbit and the medial deviation of the medial wall of the right orbit. The visualized portions of the mastoid air cells are clear. 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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is fetal origin of the posterior cerebral arteries bilaterally associated with small P1 segments. The A1 segments are similar in size. The anterior communicating artery appears small. The left vertebral artery is slightly larger than the right vertebral artery. There is thickening of the walls of the right vertebral artery along its proximal intracranial segment and distal extracranial segment without significant stenosis.
1.Subacute infarction in the left middle cerebral artery territory as detailed above associated with the a small area of hemorrhagic conversion.2.Small focus of encephalomalacia is present along the right occipital lobe. Most likely this is related to remote cerebral infarction. Please note that there is fetal origin of the posterior cerebral arteries.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Findings suggest an old right orbital blowout fracture.