 MRI brain: The study is degraded by motion. There is a large confluent area of restricted diffusion, T2 hyperintensity, and mild swelling involving the right precentral gyrus. There are also punctate foci of restricted diffusion and T2 hyperintensity in the right middle frontal gyrus. There is a background of diffuse cerebral white matter T2 hyperintensity without restricted diffusion. There is encephalomalacia in the right pons. There is diffuse cerebral volume loss. There is no midline shift or evidence of acute intracranial hemorrhage. MRA brain: There are atherosclerotic steno-occlusive lesions of the M1 segments of the middle cerebral arteries bilaterally. The middle cerebral arteries are patent up to the level of the bifurcation. The anterior cerebral arteries appear to be patent. However, there are also atherosclerotic irregularities of the internal carotid arteries bilaterally. There are also atherosclerotic irregularities of the V4 segments of the bilateral vertebral arteries. The basilar artery appears patent. The posterior cerebral arteries are patent. The anterior cerebral arteries are patent.
1. Early subacute infarct involving the right precentral gyrus and to a lesser degree the right middle frontal gyrus, without evidence of hemorrhagic transformation or midline shift.2. Chronic right pontine infarct and diffuse chronic small vessel ischemic disease of the cerebral white matter.3. Atherosclerotic steno-occlusive lesions of the M1 segments of the middle cerebral arteries bilaterally and V4 segment of the vertebral arteries bilaterally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.