 Foci of restricted diffusion with matching ADC hypointensity and T2 hyperintensity can be seen scattered throughout the right and CA territory, most predominantly affecting the parietotemporal region. There is no parenchymal enhancement, although there is associated vascular prominence.Separately, there is a small focus of enhancement involving the middle right frontal gyrus without associated mass effect, T1 or T2 signal abnormality, but demonstrating a small amount of susceptibility hypointensity.Redemonstrated is encephalomalacia involving a significant portion of the left MCA territory distribution with gliosis and hemosiderin staining. There is also commensurate ex vacuo dilatation of the left lateral ventricle and right to left midline shift. There is also associated Wallerian degeneration of the left cerebral peduncle. There are a few scattered punctate foci of T2 hyperintensity in subcortical and periventricular white matter locations without restricted diffusion representing chronic small vessel disease.The cerebellar tonsils are in normal position. There are no masses. Note is made of a partially empty sella. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.
1.Acute ischemia involving the right MCA distribution.2.Separately, there is a small focus of enhancement involving the middle right frontal gyrus without associated mass effect, T1 or T2 signal abnormality, but demonstrating a small amount of susceptibility hypointensity. This is of uncertain etiology, however may represent a mycotic aneurysm from septic emboli, metastasis, less likely older/resolving infarct.3.Old left MCA distribution infarction.4.Results were discussed with Dr. Mansour on 10/3/2016 at 9:20 AM.