Male, 57 years old, with left hemianesthesia, concern for MCA right thalamic stroke, subacute. A 4 mm focus of restricted diffusion is seen within the right thalamus. Patchy minimal diffusion hyperintensity in the right frontal lobe likely represents T2 shine through artifact. Scattered foci of T2 hyperintensity within the cerebral hemispheres are seen. No evidence of significant edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. Numerous foci of susceptibility are evident including within the right frontal lobe, the basal ganglia, right thalamus, brainstem and cerebellum likely indicating chronic microhemorrhage. Ventricular size morphology are within normal limits. A 10 mm cystic structure with a fluid-fluid level is suspected in the right superomedial periorbital soft tissues.Mild to moderate stenosis is detected at the right distal M1 segment and at the bifurcation. A moderate stenosis affects the proximal inferior division of the right MCA. No other significant intracranial stenosis is seen. No aneurysm or vascular malformation is suspected.Common origin of the brachiocephalic and left common carotid arteries is seen. No significant vascular stenosis is detected in the carotid vessels of the neck. The left vertebral artery is dominant. No significant stenosis is seen within the cervical portions of the vertebral arteries.
1.A small focus of diffusion restriction within the right thalamus is seen compatible with an acute to subacute ischemia.2.Numerous scattered foci of T2 hyperintensity and scattered areas of microhemorrhage are demonstrated likely related to chronic microvascular ischemia.3.Mild to moderate stenoses are evident at the level of the right MCA bifurcation. Elsewhere, no significant intracranial vascular compromise is detected.4.No significant vascular compromise is seen in the neck.5.Incidental note is made of a small cystic structure within the right superomedial periorbital soft tissues.