Diagnosis: Unspecified cerebral artery occlusion with cerebral infarction Unspecified cerebral artery occlusion with cerebral infarctionClinical question: evaluate for new strokeSigns and Symptoms: L sided hemiparesis and sensory loss The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergae.There is encephalomalacia involving the right cuneus. There is no associated focus of diffusion restriction on the current exam. On the prior exam from March there was a diffusion restriction in this location.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Since the prior examination the patient has developed several subcutaneous nodules adjacent to the left parietal bone and left lambdoid suture. The largest one measures 10 mm in size. They are high signal on T2 and low signal on T1 imaging. They are not associated with diffusion restriction.Images were acquired using fast imaging techniques. More subtle abnormalities may be overlooked as a result.
1.There is continued evolution of a cerebral infarction involving the right cuneus which is now in the chronic stage.2.There is no evidence for acute ischemic cerebral infarction.3.Heterogeneous nodules along the left parietal scalp soft tissues near the lambdoid suture most likely represent sebaceous cysts but are nonspecific. Please correlate with clinical findings on physical exam.4.Images were acquired using fast imaging techniques. More subtle abnormalities may be overlooked as a result.