53-year-old male, evaluate for acute ischemia, history of complex partial seizure with left weakness and neglect. There has been marked progression of encephalomalacia and gliosis centered in the right inferior parietal lobule extending into the superior parietal lobule and posterior superior temporal lobe as well as involving the right centrum semiovale and right corona radiata corresponding to the regions of previously identified infarction. Associated susceptibility artifact likely represents chronic blood product. There is mild ex vacuo dilatation of the posterior horn of the right lateral ventricle. Note is made of T2 signal abnormality compatible with Wallerian degeneration in the right brain stem. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. No evidence of acute infarction, acute hemorrhage or mass effect.2. Encephalomalacia and gliosis with chronic blood product is centered in the right inferior parietal lobule extending into adjacent superior temporal gyrus and superior parietal lobule. The territory involved has progressed significantly since the prior MRI at the time of acute cerebral ischemia in this territory. There is associated wallerian degeneration.