Reason: r/o occlusion stenosis History: concern for acute ischemia, aphasia, right side weakness. History of lupus and renal failure (Creatine of 3.0 eGFR =19) MRI of the brainThere is a focus of diffusion restriction involving the left inferior frontal gyrus, left insular cortex and adjacent centrum semiovale with patchy extension into the left middle frontal gyrus. This does not have significant FLAIR abnormality associated with it.There is a small focus of FLAIR abnormality without diffusion restriction in the subcortical white matter of the left frontal lobe which can be identified on the recent CT scanner as the area with cortical calcifications.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is occlusion of the left MCA at the superior division. The left MCA inferior division is patent.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.The anterior communicating artery is identified and is small. The posterior communicating arteries are readily identified and are small. The vertebral arteries are similar in size.
1.There is a focus of hyperacute infarction along the central portion of the superior division of the left MCA territory.2.A smaller focus of encephalomalacia due to ischemic injury in the left inferior frontal gyrus is associated with gyral calcifications.3.Occlusion of the superior division of the left MCA.4.Findings were discussed with Dr Goldenberg at the time of the exam. It was decided against intervention at this time.