79 years Female (DOB:4/10/1937)Reason: Evaluate for lesion bulging into 4th ventricle History: pls see abovePROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG FERNANDO D. GOLDENBERG There is diffusion restriction and T2 and FLAIR signal hyperintensity present along the right lentiform nuclei, right caudate nucleus, right insular cortex and a small portion of the right inferior frontal gyrus as well as part of the right hippocampus. Additional focus of diffusion restriction is present along the right precentral gyrus and adjacent posterior aspect of the right middle frontal gyrus. There are punctate foci of diffusion restriction along the right temporal, right occipital and right parietal lobe in the MCA and PCA distribution.There is a 12x8mm low signal ring associated with a popcorn like appearance centrally on T2 centered in the right tectal plate centered along the inferior colliculus associated with susceptibility effect.A small focus of susceptibility is present in the right basal ganglia along the posterior aspect of the putamen within infarcted tissue.Small focus of susceptibility is present in the right sylvian fissure.Punctate foci of signal loss on SWI are present in the brainstem including midbrain and pons. There is patchy contrast enhancement along the upper brainstem.Perfusion imaging is degraded by patient motion.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 have scattered opacities. The visualized portions of the orbits are intact. The visualized portions of the orbits are intact. The eyeball lenses are thin. There is a scleral band along the left eye.
1.Subacute infarctions along the right basal ganglia, and insular cortex in their entirety as well as small portions of the right precentral and middle frontal frontal gyrus and right hippocampus with punctate foci in the temporal and parietal lobes. There are small foci of hemorrhage in the right basal ganglia and surrounding the right MCA in the sylvian fissure.2.Cerebral cavernous malformation along the right tectal plate centered along the inferior colliculus.3.Microhemorrhages are present in the brainstem. One possibility is that there is a small DVA present which is obscured by motion artifact.4.Patchy enhancement in the brainstem is of uncertain significance.5.Perfusion imaging is degraded by patient motion.6.Post contrast imaging is degraded by patient motion which may obscure more subtle abnormalities.