Clinical question: Acute ischemic infarct with hemorrhagic component. Signs and symptoms: Left MCA syndrome. Nonenhanced brain MRI:Diffusion weighted images demonstrate acute hematoma in the left basal ganglia. Additionally there are small punctate and linear restricted diffusion involving the cortex of the left anterior frontal as well as left periventricular white matter in the lenticulostriate distribution medial to the hematoma.The left nasal ganglia acute hematoma and its surrounding vasogenic edema results in mass effect on the left lateral ventricle and with trace distribution of midline to the right without significant change since prior exam.Additionally the study demonstrate findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.The signal void of major intracranial arterial branches are present.The signal intensity of the intracranial venous sinuses are within normal.Calvarium, orbits and paranasal sinuses are unremarkable.
1.Punctate cortical and linear left basal ganglia restricted diffusion as detailed above.2.Acute hematoma in left basal ganglia, surrounding vasogenic edema and trace deviation of midline to the right demonstrate no significant change since prior exam.3.Mild chronic nonhemorrhagic small vessel ischemic strokes are also noted primarily in the supratentorial brain parenchyma.