Clinical question: Evaluate for ischemia. Signs and symptoms: AMS and nonverbal. Nonenhanced brain MRI:No convincing evidence of an acute ischemic stroke however diffusion-weighted images demonstrate mild restriction in the large focus of edema and hemorrhage in the left posterior temporal lobe-parietal, posterior pons and left medial aspect of cerebellum on multiple prior exams.A previously known left posterior pontine cavernoma is again identified and measuring approximately 18 x 17 mm in transaxial dimensions. Fourth ventricle is mildly compressed similar to prior exam and in midline.Edematous/hemorrhagic changes in the left posterior temporal and parietal with resultant regional mass effect demonstrate no significant change since prior exam. FLAIR/T2 hyperintensity in the left inferior cerebellum with subtle mass effect on the fourth ventricle remains also similar to prior exam and representing postop change.Normal size of supratentorial ventricular system and trace deviation of midline to the right is identical to prior study.
1.No evidence of acute ischemic stroke.2.Patchy foci of restriction in the large region of edematous/ hemorrhagic changes in the left posterior temporal-parietal, posterior pons and left cerebellum are noted.3.Stable focus of edema and hemorrhage in the left posterior temporal/parietal and left cerebellum with resultant associated regional mass effect since prior study.4.Stable cavernoma measuring approximately at 18 x 17 mm transaxial dimensions.5.Stable nondilated supratentorial ventricular system and with trace deviation of midline to the right